Help!!!

Hi Everyone, I was hoping someone here could shed some light on an insurance question for me. My husbands job is having open inrollment coming up and I have the option of choosing between BlueCross, Cigna, or United Healthcare I've gone over all the policy's on my husbands employers website and thank goodness all three cover gastric bypass!! My only problem now is finding out what these company's consider to be medically ness. I've been able to read Bluecross, and Cigna's but no matter what I do, UHC keeps all their info under lock and key,there website is for members only and on the phone they won't tell me anything but that It's covered. Does anyone know what UHC policy is on medical ness. for WLS? If I can't find out I think that I'll switch to Cigna, ( there req. are reasonable ) thanks for any help!!!!

I don't know anything about WLS and UHC, but when I had their insurance, they were a pain to deal with. I have Cigna now, and they paid for my WLS without much hassle at all. Good luck! Take care, Ashleigh -43

Hi Jacqueline, from the ones who have BcBs, they can be a pain. You have to see their Dr.'s, go to their pharmacy's, and they don't always want to pay. My parents have to fight with them constantly. A lot of private insurance companies want you to have 6 month Dr. Supervised diet program prior to agreeing to have the surgery. Be sure to check into that. Sorry can't help you much more then that. I have medicare and don't need prior approval or meet any requirements. Best of luck in your decision. Always, Kathy

I have UHC and no, they don't give info up front but as far as what is considered medical necessity, BMI >40 and 100 lbs over ideal body weight. If you meet those criteria, it will take about two weeks for them to review your records and give you the approval or denial. I had a BMI of 47 and was 137 lbs overweight and was approved no questions asked with sleep apnea being my only co-morbidity. If you have any other questions, please feel free to email. Toni

I have United healthcare and they were confusing and awful, but it turned out okay. I was told over phone about 5 times that WLS was covered under policy as long as BMI over 40. Based on that I made aptss. with dr.s and was sure that approval would be no problem. I was even told that approval was not necessary as long as BMI over 40! Boy was that wrong!!! I was denied the first time. They have two department--bebfits and care cordination. They use different computer systems and have different information and do NOT communicate. Benefits kept telling me I was okay for surgery. Care Cordination kept refusing me and saying it was excluded from my policy. Benefits said it was specifically INcluded on my policy. I begged for a conference call so benefits and care coordination could talk to each other and figure out who was right. They wouldn't or couldn't. I fought so much finally a supervisor became involved. He finally approved me and said the problem occurred because care coordination hadn't updated their files and so didn't have the correct info. Since this surgury has been covered for years with my policy, I can only imagine how long it has been since they updated files! Imagine all those people who don't fight and are denied!

I have CIGNA as my primary insurance and also am employed by them. They required I do a 6 month supervised diet, be seen by a nutritionist, and have a psych visit. I was denied when they first sent the stuff in but found out my gastric surgeon's office only sent 12 of the 60+ pages I gave them to prove need. I appealed it myself and got approved with my first appeal. I also have BC/BS of IL as my secondary insurance. I sent them the exact same stuff as CIGNA yet never got them to approve my surgery. Wasn't a big deal as I'd met all of my yearly deductible for CIGNA except $37.50, so that was how much I paid out of pocket. Good luck. Kelly Open RNY 10/19/04 383/363/230/165