United Healthcare Insurance

PSoftGirl,

I definitely am keeping my hopes up. I really think that things will work out in my favor.
I have been looking into the VSG, but apparently my particular plan does not cover it. So, I am leaning towards getting the LapBand instead.

How is your VSG working out?

I also have UHC Choice Plus.  I originally started looking into WLS last November - without even deciding if I wanted to go through with it (or whether I liked the surgeon) - they submitted to UHC and I was approved - I did not like that surgeon and so I didn't go through with it.  I was nervous I wouldn't be approved this time because of the previous approval (and then not going through with it) but I found a new surgeon and met with him beginning of July and I found out yesterday that I was approved (for lap band)....good luck - hope you get a quick approval

i have UHC and they cover lap band and RNY, not the VSG which I want to get.  Anyone had any luck appealing such a situation to get teh VSG when it wasn't originally covered?

Well, I finally have all my paperwork in order and it will be submitted to UHC either tomorrow or beginning of next week. I have everything I need to qualify, I just hope they don't try to find a reason to deny it.
I am really trying to get this surgery done this year because the company I work for was sold this week and rumor has it that the insurance we will have next year will not be nearly as good as what we have now.
I need to take advantage of the fact that they do pay for bariatric surgery. Who knows if I can do it after this year. Well, I'm sure I can, but it's a lot more painful when the money has to come out of my pocket. 

UHC Choice Plus is the network that UHC uses for providers. You need to check your actual policy to see if WLS is covered. I have UHC (And am a UHG employee) and it is not covered for me. Thank God I have my DH's insurance as a secondary and they do cover it....so I am 4 months into my 6 month program and am hoping to have an approval in November and sugery in December. Please double check your policy.

I have checked my policy through my HR department. I made sure it was covered before I got all worked up and excited about the possibility of having the procedure.

I have done all of my research and now just need to wait on the insurance to submit their approval.

I was just told by UHC they wont cover my surgery because im not 21. My surgeon is doing everything he can to appeal that because he said it was a ridiculous claim and hes done patients as young as 16. Im tired of waiting. My friend had his when he was 20 why cant i? :(

I am sure you will get a letter, but I would ask them specifically for the documentation in your policy (or certificate of coverage) that excludes WLS coverage for those under 21.  I see no mention of it in their online medical policy (Policy Number: 2012T0362P; Effective Date: December 1, 2012).  It might be listed in your specific policy or cert of coverage, but usually those 18 and over are covered.

This might just be them grasping at straws to try to deny you on the first go around.  I think your doc would likely be successful on his appeal - there are just too many studies showing the benefits of surgery, especially on the younger patients.

Good luck!

What was the outcome???  I am in the process of trying to figure out if I will be approved based on my BMI not being over 35 for the past 5 years,