United HealthCare
I was just wondering if anyone out there has United Healthcare?? I have been trying to find out what their criteria is for the surgery. They in turn tell me the surgeon is the one with the criteria...............I finally did get out of them the fact your BMI is one of theirs...but duhhh that is the surgeons LOL. I cant seem to get any answers from them. I plan to go for a sleep study soon just to get that out of the way in case it was required. Anyone with any kind of information on UHC PLEASE let me know what you know!!!! THANK YOU!! 
Michelle, I don't have United Healthcare, but I have been told they were pretty good. It seems (as I have been told) that they may say they don't cover, but will after you try to get it approved. As I said, I don't know, this is what I have been told. I do wish you the best of luck. Take care.
Sara.
Hey Sara!
The first time I called UHC they told me that they DO cover weight loss surgery. I did call back again later and spoke with a different rep and was told the same thing. I have since talked with care coordination but still cant get a straight answer on the criteria question! I want to schedule my surgery before the end of the year since I have already met my 1000.00 out of pocket for the year. I wonder if the doctor would do that or think I'm being cheap??? If I wait till Jan then I have to pay the 1000.00 again. Oh well...I'm full of questions LOL I need to sit back take a deep breath and not worry!! Thank you for your reply Sara 
Michelle,
UHC is the BEST company with whom to deal for WLS. The ONLY criteria they have is that you be morbidly obese. Any other criteria is your particular policy-holder's -- not UHC's. You need to read your exclusions page thoroughly as the only time that UHC doesn't cover WLS is when there is an exclusion on the policy -- check with your HR department and have them double-check the policy for any glitches/requirements. Hopefully, your employer has an un-excluded policy and you will see approval very quickly (they pretty much approved my surgery over the phone when my surgeon's office called to find out where to send my info!). Just relax, breathe and do all the pre-op tests even if UHC doesn't require them -- if it helps your surgeon do the best job, then it's worth it!
--joanna
325/134/140
Michelle,
I went through the same BS with them, all they would tell me up front is that you have to have a BMI over 40. I was approved in a very short amount of time but my surgeon required extensive testing before he would accept me as a surgical candidate so there was really no question of medical necessity, he proved it with all his testing.
I would recommend that you work very closely with your surgeon's insurance coordinator as s/he would have the past experience of what they've submitted to UHC before to get approvals.
Good luck.
Toni
Hey Michelle,
It really depends on what your company is willing to pay for. Everyone wants to yell about what ins. will or won't pay for these days, when in reality it is up to the company you work for. They make the decisions on wether to buy the policy that will allow their employess access to certain medical treatments or elective surgeries. Insurance is just the enforcers for what your company decided to buy for their employees.
With that said **my** experience with UHC has been absolutely wonderful. They have covered several surgeries that either myself or other members of my household needed. Our daughter needed a plastic surgery for work on a scar she has from a car accident from years ago(pre UHC coverage) and they didn't balk or say it was pre-existing or elective or unnecessary...they just covered it and went on about their business.
Your surgeons insurance specialist knows how to bill this to get it covered if your company doesn't have an exclusion. Talk to your HR representative and find out if there are any exclusions that they know of, usually you can get a good idea of how ins. is going to act by talking to HR.
**Again my experience with UHC has been nothing but wonderful. They did make me wait the 30 days to get an answer on pre-determination. But that is not a fast rule, they approved my DH for surgery in like 2 weeks time.
HTH,
Trisha
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