United Healthcare

I am insured with United Healthcare PPO through Volt Information Sciences, Inc. I just called United Healthcare for information about their coverage for bariatric surgery. Here was their response: - They do not cover non surgery-related weight loss treatment. - They do not cover surgery if your BMI is above 35. This seems very strange. If you had a BMI of -35, I don't think you'd be looking into surgery! I'm really not sure what to do. Have any of you successfully worked with United Healthcare to get WLS coverage?? Much thanks. Emily

Adding to my post. I'm going to ask them to send me the policy. This is just odd. That being said, do any of you recommend a PCP around Seattle or Redmond who "believes" in WLS? My doctor does not... What an amazing site. I'm so happy that a friend showed it to me!

My PCP is at Virginia Mason. If your insurance covers you to go to VM, they're a great facility. My doc (Julie Patterson) is an internist, and she recommended WLS to me (I've been her patient for several years). Two VM Drs do RNY: Dr. Thirlby does open, and Dr. Hunter does lap. From everything I've read, and all the contacts I have, both are excellent. Several people on this site have one or the other of those 2 docs. I believe Kimanne has Thirlby, because he takes the kind of medical coverage she has. I believe Terry is having Dr. Hunter, and she's scheduled for surgery 1 week from today. Hang in there, and explore all your options. If you've chosen this journey, or God is leading you this way, He'll open the doors that need to be opened when the timing is perfect for you. We'll keep you in our prayers. Please continue to come to this board, and let us know how we can help you out anytime. Hope this helps, Susan

Maybe the comment "do not cover surgery if BMI is above 35 is a typo?????" I'd sure check it out!

I know Emily, it is hard to figure out all this. I also have United Health Care PPO and I got the exact message you did. Except my person said that they only cover surgery if your BMI is over 35. I tried to figure out what they needed to see if I qualified, my BMI is over 35 so that was not the issue. In the end Dr Moonka's office at Virginia Mason sent in the request and it was approved in ONE WEEK! Give this info you have to your doctor and see what happens, I was so pleased at how well it went for me. You can always call United Healthcare and talk to a supervisor - I did and they straightened a few issues out for me. I think we are so excited that we have trouble getting it all straight. Good Luck. A

I don't even know what to say. You are all so kind and helpful. I can't thank you enough. I went to the United Healthcare Web site (www.myuhc.com) to search for more information. The only thing I could find was that they don't pay for "weight management" programs. I assume that's things like Jenny Craig (been there, done that). I read the whole policy. United Healthcare phone people said that I can read my policy online or talk to my employer's HR department (no *way* do I want my employer to know about my health care) and that they won't send it to me. The phone person is also the person who said they cover surgery only on people who have a BMI *under* 35 (I even had him reread it to me). I don't really want to fly blindly into oodles of copays until I know whether they really cover it; I want it in writing. Ideas? I could just call tomorrow and ask them again to send me the forms. I just have a feeling that they're going to tell me to talk to HR or look online again... *sigh* Emily

My last update to the sagga. I called United Healthcare again and asked a supervisor to read the clause again. She too read "a bmi under 35." To which I replied, "that just doesn't make sense," and then I went into definitions of obesity with her. She said I could (you guessed it) ask my HR department at work for a copy of the clause... **I can see it now, "Hi work HR person. I'm obese and need time off from work and this really expensive surgery. Please give me the information about how to make you pay for all of it." (My employer carries the policy and United administers it.)** So I told her that I know someone who has the same insurance and had her WLS paid for by United. I asked the kind supervisor for information from her about how that could be true. AH HA! So, she says, if my doctor deems WLS "medically necessary" they'll cover it. I'm in shock. It was that easy all along! SHEEEEESH! And here I thought that I'd magically have to get my BMI down 6 points. Excitement. I'm meeting two of you in the coming weeks to talk about WLS. I can't believe how generous all of you are. I'm all alone out here without family; it's so nice to meet people *****ally take interest in my health. Kindly, Emily