I want to be a loser...

Hello everyone, trying to get approved for WLS, I have UHC Platinum, and I've called and was advised that they do cover it, but couldn't tell me what criteria I have to meet. Now if my insurance company won't tell me, who will? I'm not supposed to have any out of net-work benefits, so I was just looking at Scottsdale Bariatric, but the Ins Co. said I could go to the Barix Clinic, and just pay out of network.....HUH???? I need a referall from my PCP, and he's says I need to reduce the stress in my life and eat less, and exercise more....Great, I've been overweight for 10+ years, and I never thought of that.......I thought going to my insurance co first would be a good thing, but I don't know what to do now.....Any suggestions? TIA Alli

Alli - Congrats on taking the first step. I have UHC and when I called to ask about coverage they said they only require a statement of medical necessity and that you are morbidly obese. I did get approved this week without any hassle! My surgeon is Dr. Terry Simpson and his coordinator also had UHC so she knows how to word submittals to them so you may want to think about him. He has a website www.drsimpson.com and I even think they are having an into seminar today (he's at 19th Ave and Maryland). FYI: Dr. Simpson is in network for us also. If you want more info you can e-mail me offline. Take care and good luck! Kathleen

Congrats Alli! I work in the Bariatric industry and as a blanket rule of thumb, UHC is the best insurance available for getting approval. Their hoops are minimal compared to others. Needed: 1. Letter of Medical Necessity from Primary Care Physician 2. Psych Evaluation In addition...."If" you are over 50 years old then your Weight Loss surgeon will most likely require an EKG with interpretation and a Cardio workup Good luck! I think the programs you mentioned are excellent choices! .....I'd recommend going to at least 2 FREE surgeon's seminars before deciding. UHC covers Rny AND Adjustable Lap Band surgery. Joyce

Hi Joyce, I have a question regarding UHC. I have the option of switching insurance in November when my job has open enrollment. Since I am already on BCBS, would it be a problem switching while in the middle of trying to get this surgery approved. Would it be odd to switch insurance and then all of a sudden request surgery? I have had BCBS all my life, my dad was a cop back in NY, so he had Empire BCBS and then majority of my jobs were all BCBS with the exception of 6 months when I had United at my current job before they signed with Empire... but I can go back to United in November. Just wondering if that would be worth it... especially after seeing how strict BCBS is with approvals and so on. Thanks for the info!

I got UHC in april when I started a new job and my paperwork was sent in the next month. No problem. Lamont

Nicole, Insurances can't have any rules attatched to when you make your claim. I'd xuggest going through all the hoops with BCBS and then when it's open enrollment SWITCH. You would most likely be ablet to submit asap and would most likely get your approval with 20 days. I think they officially have 30 to respond. ....But...before switching.....make sure that your employer does NOT have an exclusion for WLS with UHC!!!! Have any other employees used UHC for WLS with your current employer? ....... Wouldn't want you to switch and then find out there' s an exclusion. BCBS is the MOST difficult insurance to work with for WLS in my opinion (but I submit for Lap Bands and Rny's are sometimes a bit different). Shorter answer: Nope it wouldn't be a big deal to make a claim immediately upon switching. Good luck! Joyce

Thanks to everyone that replied. I start again on Monday with the Ins. Co, and am planning on going to the next seminar at Scottsdale Bariatric Center. Is anyone else out there going? I think it's on 8/27, I would love to have a loser buddy Also, I had information in my profile, and now it's gone. How do I update my profile again? TIA Alli