I have UHC EPO (no deductible and my plan is supposed to cover everything the PPO does as long as i'm in-network, with a copay of $10 per visit for most everything)... I spent a few hours playing phone tag today and was told:

1) my surgery is still pending decision. the medical director has it (not sure if that's normal?). my surgeons office as of this morning said they hadn't heard anything back. this submission was after the first one was closed and had to be re-opened because the UHC adjuster was being super impatient about getting the paperwork completed within 24 hours.. (my surgeons office was missing one year of weights and UHC wouldnt wait an extra day to get it faxed over)

2) although they insisted i do 6 nutrition visits and in the course of the same conversation said all pre-op visits would be covered under my plan, they are now deciding to only pay for 2 of them and now say my plan only covers 3 nutrition visits per lifetime per diagnosis... and they counted my intro bariatric class as another visit. WTF.

3) the two main radiology tests they denied (for no noted reason) - upper GI and chest xray - they told me should be covered and the doctors are in-network YET they still wouldn't fix it for me on the phone. they said they'll put it "under review" and i should know IF they fix it in 10 biz days.... double-WTF.

4) the psych eval (done a month ago, still no reimbursement) i have to deal with another UHC phone bank to make sure they cover, since i was explicitly told before making the appt by a UHC rep that it would indeed be covered.

big hassle. all of that, plus just the last few months of copays for visits, tests and such = $1500. that doesn't count the meds UHC won't cover (heavy duty iron and vit D) and prior months of copays re: surgery. i'm not made of money and my plan is supposed to cover most costs, so this is super annoying. i hope it all gets resolved soon.

My employer's healthcare plan specifically states one bariatric procedure per lifetime. However, my surgeon has stated that I require a Band Over Bypass to correct a dilated stoma (staples came out of place )....  The insurance rules this BOB a second bariatric procedure not a correction to the RNY....

Has anyone had any experience appealing for an exception/waiver to the Empoyer's Plan???

Thanks Nan. Wish the best of luck to you and your family with your WLS.

Howdy , Does anybody know if United Heath care covers VSG. My brother  told me yesterday that he is ready to have the sleeve. If United does not cover it I will write the check my brother means more to me that 10k. does.....  Hope you all had a great Thanksgiving... God Bless