Question:
Help, will my insurance cover this surgery?

Hi I am 31 years old and weigh 309lbs, 5'6" tall. I have high blood pressure, acid reflux and depression problems. Also I urinate on myself when I laugh or sneeze. I have United Healthcare for my insurance company. They told me that they don't cover gastric bypasses. Should I give up? I don't know what else to do. I have had a life long problem with my weight.    — [Anonymous] (posted on August 23, 2000)

August 23, 2000
Lots of people have UHC and have had it covered. I would be willing to bet it is your employer that has an exclusion on the policy. Check into it and by all means fight it!! E-mail me if you want add'l info.
   — ZZ S.

August 23, 2000
Everyone here has given you excellent information. I agree that it is probably the employer who has a written exclusion to this in the policy. Get a copy of the policy and its exclusions. Make yourself informed of the Exact wording here. Does it say gastric bypass, obesity, morbid obesity or what? Medical necessity is another issue. Do not take the word of the customer service person, I and many others have gotten bad information from that possibly inexperienced person. There are many people on this site who have won even with exclusions. Also, there is the possibility of having the company revise the insurance when they renew if there is pressure from the rank and file. Last year I had a bladder suspension done for the same thing you have (stress incontinence) $10,000 for hospital alone. My weight was down some before the surgery and it was successful, but when I put on 30# I again have the incontinence. The only thing that will relieve it is weight loss...I am sure of it. Maybe they would like to pay twice...I also have reflux... you are young yet-many years to rack up big bills if your health does not improve...have they paid for upper GI, being scoped, anti acid medications like Prilosec or Prevacid long term? From there it is ulcers and another surgery. You have high blood pressure...requiring meds and monitoring which will eventually if not now require a cardiologist and all those resulting periodic tests. Lab work for chol, etc.etc. If all this is pointed out the >$20,000 gastric bypass seems cheap. Add to that a happier, healthier more energetic employee. There are some other things you do not mention... is it your insurance? husbands? Could you ever get on Medicaid? Can you change insurances...every detail has to be looked at. Best of luck
   — JennyLynn A.

August 23, 2000
Everyone here has given you excellent information. I agree that it is probably the employer who has a written exclusion to this in the policy. Get a copy of the policy and its exclusions. Make yourself informed of the Exact wording here. Does it say gastric bypass, obesity, morbid obesity or what? Medical necessity is another issue. Do not take the word of the customer service person, I and many others have gotten bad information from that possibly inexperienced person. There are many people on this site who have won even with exclusions. Also, there is the possibility of having the company revise the insurance when they renew if there is pressure from the rank and file. Last year I had a bladder suspension done for the same thing you have (stress incontinence) $10,000 for hospital alone. My weight was down some before the surgery and it was successful, but when I put on 30# I again have the incontinence. The only thing that will relieve it is weight loss...I am sure of it. Maybe they would like to pay twice...I also have reflux... you are young yet-many years to rack up big bills if your health does not improve...have they paid for upper GI, being scoped, anti acid medications like Prilosec or Prevacid long term? From there it is ulcers and another surgery. You have high blood pressure...requiring meds and monitoring which will eventually if not now require a cardiologist and all those resulting periodic tests. Lab work for chol, etc.etc. If all this is pointed out the >$20,000 gastric bypass seems cheap. Add to that a happier, healthier more energetic employee. There are some other things you do not mention... is it your insurance? husbands? Could you ever get on Medicaid? Can you change insurances...every detail has to be looked at. Best of luck
   — JennyLynn A.