United Healthcare

I have United Healthcare and it contains an exclusion for bariatric services. I think that I can appeal the exclusion if medically neccesary. Is this true? What surgeons would you recommend.

Hi Ticia, I have United Healthcare as well. Before they would approve surgery, I had to provide documentation from my primary care physician stating I was not only a candidate for the surgery, but also documentation regarding my medical history as it related to my candidacy for the surgery. Basically, it needs to be proven that the surgery will improve the overall quality of your life and health. Upon a recommendation from a friend, I contacted Dr. Robin Blackstone's office at the Scottsdale Bariatric Center. They sent me an extremely helpful and thorough packet of information describing the entire process. The packet is extremely comprehensive, detailing each and every step you need to take. While there are other choices in Arizona, I can only speak of my experience with Dr. Blackstone, which was not only seamless, but pleasant and impressive. Aside from searching posts here, check out the link to the left titled "Bariatric Surgeons" to see a few other surgeons and their stats. Hopefully some others will reply with their input as well! Good luck to you and keep us posted! Nicole

Tricia Your company has the exclusion on the policy , Talk to your doctor and have them start the process - you may need to also ocntact your H.R. dept to see if there is an exception to thier rule . The more documentation you have the better you will be to fight this battle - & its going to be a battle ..

I have United Healthcare and it was a breeze. However there was no exclusion policy. Good Luck!!

Ticia, I have UHC and they had an exclusion, however with the morbid obessity diagnosis from my PCP , I was approved very easily. It's your employer that has put in the exclusion so you have to find out what that is. I too would recomend Dr. Robin Blackstone, but I would first before going down the road find out exactly what will override the exclusion. Sometimes with other health issues, high blood pressure, sleep apnea, etc. will help if your BMI is low. That was also the case with mine and my husband, we had other issues along with the diagnosis. Good Luck, hope this helps.

Carole, I work for the Catholic Diocese and I spoke with HR today. They would not address the exclusion other than to say that the Dr. needs to initiate the process. I am assuming that not covering a medically necessary procedure is in direct opposition to the Americans with Disabilities Act. Can yu recommend a internist or primary care that is familiar with the process? Oh, and how long did the process take from start to finish for approval. Thanks for responding, Ticia

Hi Ticia, every policy and company is different, but my experience with UHC is this: my husband works for OfficeMax, has United Healthcare with an exclusion for weight loss surgery. No appeal, nothing, can get around it - it is excluded no matter what. I have spoken w/the Director of HR Benefits, stating my case (high BP, sleep apnea, high BMI, cholesterol, etc - of course, they pay for all those meds, go figure...), but the bottom line so far has been that if it's specifically excluded - that's it - it's excluded. I hate to be the bearer of bad news and maybe your situation will be different, but that's my sad story

The process was only about 30 days, but my primary care doctor had nothing to do with the insurance co. He only wrote the letter that was addressed to Dr. Robin Blackstone the surgeon. Whichever surgeon your thinking of using can probably recommend a PCP. Mine has moved to Glendale, and he's only familiar with the medical necessity part. His name is Dr. Jeffrey Zacher.

Hi Ticia, I have United thru the State of AZ, was initially denied and on appeal had my surgery (sleep apnea test sealed the deal). I would suggest that you find someone with your plan who is also with your employer who has had it and also ask the surgeons if they have had someone with your plan and done surgery. My ins. said the same but the reality is if someone has had the surgery with your plan. I started getting serious about the surgery and approval in May 06 and had surgery Nov. 06, but all drs are different. I had Blackstone, but not sure if she'll be taking United after 6/1. Best Wishes! Katie

Ticia, I also have UHC through my employer at Raytheon I was approved in 5 days no problems. Good Luck Diane