Question for those who have been denied.

Hi Everyone, I have noticed lately that there have been some insurance denials. I have a few questions on this considering I am pre-op. First, prior to meeting with the surgeon, did any of you contact your insurance company to see if this was a covered benefit? Second, if you did contact them and they said it was covered and you were still denied, what were the reasons? I have United and I was told through Care Coordination that it is covered if medically necessary. She checked my insurance and she said it would be covered, etc... Of course, I am still worried I would be denied. If I was told it wasn't covered, I wouldn't have even attempted to go through this entire process. I am just wanting to get some feedback, especially from those who have United (but others as well!) Thanks Everyone!

Hi Marcie, I have Aetna POS and they cover it. They denied me based on that I did not have a 6 month physician supervised weight loss within the last 2 years. Of course they don't tell you this ahead of time. I appealed after I complied and then they accepted. Hope this helps, Christine

I have united health,, and after all my testing information was received by them,, I got approved in 5 days,, it took longer to get my letter in the mail then for them to review my information,,, I didnt need a weight history either,, I had one prepared just incase,,,,, good luck,,, Oh within 2 months from my initial wls seminar I had my surgery,, I was ontop of all my dr. appointments,,,

Sounds like you a worrier, just like me! United Healthcare rocks, in my opinion. We called from my surgeons consult office to find out if there was a written exclusion, and were told there wasn't, it just had to be medically necessary. When we sent for approval, it was approved in less than 24 hours! They asked for very minimal information, and didn't even seem concerned with weight loss history, other than a brief outline of things I had tried. The fact that I had several co-morbidities, plus the required BMI, seemed to be all they needed. I have been very pleased with the service.

I have United Healthcare and was approved in 4 days. My BMI was less than 40 but I had some health related issues and a strong family history of stroke at early age. They paid everything in a timely manner -- no hassle whatsoever. Good luck.

I also have United. I was told by my benefits coordinator at work that it was covered if medically necessary, however, I found out that when they renegotiated our contract in March, United took out the clause if medically necessary. It is excluded no matter what. So definitely check with United directly. I am now going the self pay route. But know that it is worth it.

I had United Healthcare as my insurance and it was covered. We called in advance and found out that gastric bypass was covered by my policy. Like others, I was approved really quickly and had my surgery in less than 60 days from attending my surgeon's seminar. As long as gastric bypass isn't excluded by your policy it should be pretty easy and simple. Aylene lap RNY 4/13/04 278.8/210.5/150ish