Worried Insurance won't cover it

Hi,

I'm new here and looking to have the VSG...my doctor is telling me she can prove it's medical necessary that i have this procedure. But when i call my insurance company they state it is not covered at all. But I also work for my insurance company and see plenty of cases being approved for the surgery. So do they just say they won't cover it, but will in the end. Has anyone else had issues? I'm insured through United Healthcare.

I also have United Healthcare and I called last week to make sure everything looks good on their end (they're always telling me that I need to update my "other insurance info" even though I have no other insurance), and the rep I spoke with insisted that bariatric surgery is not covered under my policy. The insurance lady at my surgeons office had already spoken to them to make sure it was covered, and now I've already gotten my letter of approval, too. If it was me, I'd just listen to what your surgeons office says about it because they talk to different people who might be more familiar with the specifics regarding bariatric surgery. 

Thank you so much. I was starting to get a little nervous :-(

You need to request a hard copy of the wording for YOUR policy and what it says.

Thank you. I will do that too.

My surgeon's office won't even schedule an initial appointment until the patient has called their insurance and asked 2 questions:

1. Does MY policy have a bariatric surgery rider (has to be purchased as additional coverage by your policyholder)?

and

2. Is there a required physician supervised diet?

after these questions are answered they can figure out how to proceed. I would call the member services number on your card and ask those questions specifically. If the person you speak to doesn't know the answer, ask to speak to someone else. 

Thank you Annie and I wonder why they tell you it isn't approved??

My personal experience from calling was that the regular member services reps don't really know about the processes and coverage for this, but Anthem (my insurance) has a dedicated department for this kind of thing, and that department (if you can actually ever get ahold of someone) has all the answers you would need. 

I have UHC too, and on the covered services on the website it says not covered.  But, it is covered because I was approved today. 

UHC policies can vary in their coverage depending on HMO vs. PPO vs. private savings policies and which state you are in and whether your employer chose to exclude it from a group plan (if the policy is through work)

 You need to get the specifics for YOUR policy, IN  WRITING.