United Health Care

Hopefully someone has an answer.  I am going thru the process and would like to know if anyone has gone thru United Health Care. MY BMI is 41. Policy has the following exclusion "Surgical treatment of obesity excluding severe morbid obesity (with a BMI greater than 35) is excluded". Has anyone gone thru UHC with this exclusion and has the surgery been approved? thanks. [email protected]
 
 

I had posted a response to this earlier but I just reread what you posted and need to correct what I posted. If your BMI is over 35 then you should be covered. The part of your statement that I put in blue is what I am referring to. They write these things to be very confusing. Just substitute the word except for the first 'excluding'.  

"Surgical treatment of obesity excluding severe morbid obesity (with a BMI greater than 35) is excluded". 

If I am interpretting this correctly the BMI needs to be at least 35 to be covered. Call them and double check.  Good luck!  

Insurance is such a pain!  Get a good company rep on the phone and ask them exactly what is covered and even the policy numbers so you can look at them on their website if they have them available.  Also, check with your surgeon's office.  Mine was particularly good about knowing the criteria for each of the insurances in the area.  We followed them to a "t" and I got approved in less than a week.  Good luck and let us know how it all turns out!

Good news!!! I contacted someone that does surgical prior appovals for WLS surgery. She said that yes - if the exclusion is written the way you have it in your post a BMI over 35 should be covered. More than likely with a BMI of 35 co-morbidities of diabetes, high blood pressure, sleep apnea etc would be needed. But a BMI over 40 is generally covered. Definately call them and find out what they require.

I have UHC and you have to have a BMI of 35 or greater with co-morbidities and a BMI of 40 with no co-morbidities.