Newbie, where do I start

I am just starting my journey.  I have United Healthcare and I was told I need to call them and find out what they cover before I even go for a consultation with a surgeon.  Can somebody help me and let me know if there is specifics I should find out and what kind of questions to ask.

Just ask them if your specific policy covers WLS.  If so, you can go on the Aetna website and search "gastric bypass" and pull up the criteria for medically necessary WLS.  I have UHC and had no problems at all.

You can call North Fulton Baratric Center at 770-751-2924 they will tell you when they are having their next seminar which is the first Tuesday of the month they will also provide you with a list of physicians that perform the Lap Ban and Gastric Bypass. They also know about all the insurances and can tell you what steps to take and what to do. I did call United Health Care and they told me what they would cover however, because I work of the company I work for United Healthcare required me to take a step further which I did not learn until after they denied my first process due to me not doing this. My company wanted me to do a three month diet and excersie with my doctor and needed a letter from her stating that I needed the surgery. So now I have completed that and my appeal was sent in two weeks ago and I am waiting for them to respond. Well, I hope things work out for you.  I do know that the girls at the Baratric Center are wonderful and will help you.........Etoria

Thank you all for your advice. 

I used UHC and they coverd my surgery completly. but every plan is a bit different. www.atlantabariatrics.com I used Atlanta bariatrics. - DR HART is the BEST!! And Emory Johns Creek hospital is world class. You can contact them for information on their seminar (you have to attend one before you meet with the surgeon) and they are great about helping get everything together :)

GL and keep us posted!

Well, I got shot down.  I contacted my ins. company yesterday and they don't cover any WLS.  So, I guess I will have to wait until the new enrollment period and see if there is another ins. co. that will.  Thanks everyone!!

Yeah some companies have an exclusion that omit that from what is covered. I think thats complete crap. I believe there IS a way to appeal it though.... you should look into it. Or if you want Self Pay mexico has many great doctors at great prices.  GL!

Make sure that it's not your own company that has opted not to cover WLS.  When I started looking into it, BCBS covered it, told us they did and then AFTER all my pre-op tests, told us that my husband's company had opted not to cover it to save the Co. $$$$. Grrrr........  All my pre-tests were covered since it was BCBS's fault for not verifying coverage first, but in the end, it didn't matter which insurance company we had, the company would not approve it (and yes, we appealed to the company).  Ended up with self-pay in the end.  So, check with them before you wait until the next enrollment period.  If the company opts not to cover it, you may even have some time to rally for it before they do the next enrollments. Good luck!!!!

Don't forget to look into vertical sleeve gastrectomy as well as RNY and lap band.  Since *I'm* going for a sleeve, I think everyone else should, too, ha ha!  (Sorry, other procedure folks, and no offense intended :-)  My insurance won't cover squat, so I'm heading to Mexico to Dr. Guillermo Alvarez (endobariatric.com).  $10,000 flat fee covers everything except airfare into San Antonio.  There are other excellent Mexican doctors with flat rates as well.  Check out every option!   --Dorothy

Make sure that it's not the company that doesn't cover that surgery. I have United Healthcare EPO, and they cover 100% if you meet the requirements.