Question:
HAS ANYONE BEEN APPROVED WITH UNITED HEALTH CARE PPO

I have United Health Care PPO Third Party Adminstrator known as Benesight. Has anyone ever been approved with this insurance? It is listed under there Plan exclusions it reads like this... Obesity: Care and treatment of obesity, weightloss or dietary control whether or not it is, in any case, a part of the treatment plan for another sickness. Medically Necessary charges for Morbid Obesity will be covered. What is the meaning of all this? I'm 5'6, 242 bmi 39.8 and suffer from headaches, feet and ankle pain, upper and lower back pain, shortness of breath, obesity runs in the family with kidney problems, high blood pressure,heart problems, and diebetes. Thanks for any info..... Heather    — Heather C. (posted on December 7, 2000)

December 7, 2000
I have not had experience with your particular insurance, but it sounds like you would be covered. A BMI of 40+ with no comorbidities or a BMI of 35+ with cormorbidities is the criteria used to determine whether treatment for morbid obesity is medically necessary. And, it sounds like you have some cormorbities, so you should qualify at 35+. But, you're already 39.8. I hate to suggest to gain weight, but the few extra pounds you might gain over the holidays would put you at the 40+ mark.
   — Gina E.

December 7, 2000
Hello Healther, I may be the person you don't want to hear from. I have UHC Choice Plus PPO and am fighting them for WLS. I to have an exclusion, but does not read the same as yours. If you have any questions let me know.
   — richter454

December 7, 2000
I was covered under United Healthcare PPO and was approved within about 3-4 weeks. It wasn't under Benesight though. Medically necessary according to what I went through with United means a BMI of 40 or more, plus co-morbidities. My BMI was 56 and I had sleep apnea, rashes and boils, Irritable Bowel Syndrome, and ankle and leg swelling. Your BMI is less than 40 but if you have alot of comorbs that .2 shouldn't make much of a difference. They requested a diet history from me, which I never gave to them and was still approved. Also, I had my family physician who I went to as a child write a letter for me telling them that I have always had a weight problem and the types of things that he has helped me with over the years. I also wrote a letter to them and shortly after the letters and my diagnosis of sleep apnea, they approved me. One thing I will tell you is that United gets things screwed up, we have had to submit my claims back more than once because they aren't paying the benefits correctly. You will most likely only be approved for out-of-network benefits, so ask them what there usual and customary is. That means that even though the insurance says they cover you 60%, they will only pay what is called the "usual and customary" for certain procedures. So if your doctor charges more than what the insurance will pay, you get stuck with the bill. I found this out the hard way. Good luck.
   — christine L.

December 8, 2000
Heather--I have the exact same insurance company! Yes, I got approved. It took 3 days. You must have supporting documentation from your doctor deeming this medically necessary. If your employer has written it into the policy, you might want to check. My husband's employer wrote it as covered but MUST be medically necessary. Good Luck! E-mail me if you'd like. My surgery is next Tuesday!
   — Toni K.

December 21, 2000
I had United Healtcare PPO - I was approved within 2 days - I simply completed the doctors questionnaire - that's it. Much Success!
   — Anna B.

December 26, 2000
I'm answering to my own post, I was apporved in 6 working days. It seemed pretty easy.
   — Heather C.