I just called UHC yesterday, as my benefits start as of 1/1/14. I asked specific questions and was told

*BMI 40+

OR

BMI 35 with medical complications etc.

no 6 month diet, no referrals, no other contributing factors other then informing them prior to surgery to avoid a fee.

good luck! :)

Hello

I am a newbie and I have UHC Community Plan through Medicaid. I have a surgeon and have completed 6 months NUT visits and Psych Eval and am as of right now waiting for the hospital to submit my papers for approval. My question is has anyone else gone thru this process with Maryland UHC Community Plan.

Thanks in advance.

Basically what happens is that they will get a nurse or a doctor to read your paperwork and medical records and make sure the insurance company is following the policy to a T.  If they are, they will likely side with the ins co.

I wish I would have known about this before you requested a an independent review.  They will have the final word.  I would have given you more info for an appeal.  That would have given the medical professional reason to side with you.  For example, studies showing that diagnostics are not the only issue when dealing with bands.  Scar tissue is what usually causes the most problems that you describe and that can't be seen until they do surgery.

They have already made it very clear.  Ostupidcare will not cover WLS at all in any state.  Their suggestion is to buy a platinum plan privately.  The cost for an obese person will be around $3K a month.

It would be cheaper to do what most self pays do.  Go to Mexico.  For a good surgeon in a safe city it will be about $7-8K.

It would appear the truth is finally coming out about Ostupidcare.  Double the premiums for a fraction of the services and no doctor.  In California already 70% of doctors are refusing to participate in this idiotic plan.  I don't know why anyone thought would could provide medical care to 18 million people with less cost than we had before.  Now the poor and the middle class have the honors of paying the most in lost jobs, taxes, and punitive costs via the IRS.  But hey, they get cheap insurance that doesn't cover what they need.

Just to give you an idea, Ostupidcare plans to pay doctors (including specialists) $24 for an office call.  That won't even cover their overhead.  I would imagine very few doctors will be able to afford to provide such care.

I am going to suggest that you rethink a sleeve.  You are a higher BMI, sleeves are not great for higher BMIs.  Don't misunderstand, I am a huge fan of sleeves, I have one!  I am 5.5 years post op from my sleeve.  But I also know the stats.  Usually a sleeve will buy you about 100-120# LONG TERM weight loss.  Many lose more, but the regain is very high for higher BMI folks.  It's not just a matter of following the rules, everyone swears up and down they will follow every bloody rule.  The problem is that higher BMIs tend to have metabolic problems and sleeves do not address that issue.

I would seriously suggest you look at DS instead.  I absolutely promise you about 5-6 years down the road you will be back here looking at info on a revision and the thing is, you will very likely be self pay by that point.   Most ins co's are going to a once in a lifetime wls.  So when you want a revision, you will be paying for it in full.

Get the right surgery type for you the first time around.  Less invasive does not mean effective.   Quite frankly, the bigger the problem the bigger the surgery necessary.