Insurance coverage

My insurance is United Health Care and while looking at the benefits I found were it says it does not cover any type of bariatric surgery. My question is this if my doctor states that I have to have to surgery due to the fact that it is medically needed due to the fact that I have high blood pressure, sleep apnea, and a few other issues, with a weight of 440 pounds at 6 feet tall and that is a BMI of 59 to 60.

Has anyone else had this problem with there insurance company      

If it specifically excludes bariatric surgery, it doesn't make any difference whether your doctor says it is medically necessary... It is still not covered.

Yes, lots of people find that their insurance doesn't pay for bariatric surgery.  It took a long time for insurance policies to cover it, then there was a significant increase in the number of policies that covered it, and now (because of health care costs) a lot of companies are dropping that "extra".  The increase in insurance premiums to cover WLS is apparently quite high.

Lora

edited to add: You already start a diet plan to get approved for surgery, so I am wondering if you start working with a surgeon's office before you were sure it was covered?  Usually that is the first thing that a surgeon's office checks before they start you on a program.

I have started the diet on the advise of the program doctor and have not talked to the surgeon yet.

I have 2 avenues that I am trying to be able get the surgery. The first choice is my primer insurance which I get through my job. the 2nd is my veterans VA benefits. I started the VA managed diet program today, it was what they call level one, which is a 2 hour class explaining the issues of a good diet plan with all the things that they fell are important and they give you a step monitor.

Level II is the 10 week intensive program that you go to class once a week and are weighed in and discuss the up and downs and other stuff and you consult with the dietitian one on one.   

I would check with your HR at your work. Many companies exclude WLS because it makes the policy cheaper. If they have excluded it I think you are out of luck with your company insurance.

I am surprised about UHC but if they won't cover it, your veterans insurance I believe would pick it up wouldn't they?  I am a "surviving spouse" so deal with ChampVA but have you checked to see if they will then cover it?

The VA has there on program for the WLS, so you have to go thru theres. I not on champs or Tricare. Oh yea BTW UHC has completely turn me down as of today so its the VA!!

Your employer chose to exclude bariatric surgery coverage, so even with doc recommendations, it won't be covered.

Now, if you can get them to change that policy, I can attest that UHC has a great bariatric surgery program, and it covers all of the common procedures (RNY, DS, VSG)

It is a small company, only has 7 employees I don't think that they even know that  they don't cover it, and besides that they would not change the coverage just for one person IMO. I still have the VA program that I have started the WLS with just incase the insurance denied the claim. (had a feeling that they would).