Help!

Hi Cindy, I'm sorry to hear you are having trouble with your insurance. I do have UnitedHealth Care of Ohio EPO and I called them the other day. They told me it is covered only for medical necessity. I am also going through my company to verify if the surgery is listed on the exclusions list. I'm almost expecting a denial the first time, but I'm going to keep at it. However, outside of my expectations for WLS, I really like UnitedHealthCare for my overall coverage. Best of luck! Denise

Cindy, I have UHC Select Plus POS (whatever all that means). There are several employees that I work with that have been approved and have had the surgery. My doctor's office informed me that they didn't think I would have a problem with approval since UHC is pretty good. I don't know that for sure yet as I'm still in the process of getting everything done prior to it being submitted for insurance. The biggest concern would be if the WLS is an exclusion in your company's policy. Good luck! Lani

I have UHC. It depends on the company you work for and if they purchased WLS coverage for their ins plan. Each company is different. For those companies that do cover WLS it is actually listed as an exclusion in the policy like this "This policy does not cover Weight Loss Surgery except for a diagnosis of Morbid Obesity" So essentialy they are saying if your PCP says you are MO then you can have the surgery. Its VERY easy compared to other plans. No x-number of years/months physician supervised weight loss efforts, no co-morbidities and none of the ever ambiguious "must be medically necessary" If your BMI is over 40 then you qualify, period. But again, that is only IF your company has purchased WLS coverage. If they have not, then no amount of begging/appeals will get you approved. When I submitted to my ins, it took them a MONTH to even acknowledge that they even had the paperwork, but after that I had my approval in 30 days. It seemed like forever at the time, but in retrospect it wasn't so bad. Good luck to you! Jen

Cindy, I bet Jaimee can offer you some good suggestions to getting around the insurance company tricks. In the meantime,also remember that your employer holds the key to some of this. Quite often, employers have the ability to make an exception for exclusions in the policy. Check with your benefits manager. Whatever you do don't give up. Nancy