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ancy89
on 7/9/13 1:49 pm
noftessa0401
on 7/9/13 6:54 am - San Diego, CA
RNY on 12/27/12
Topic: RE: Need help

This is a tough question to answer.  Not only does the coverage vary from insurance company to insurance company, it varies widely policy to policy within that company.  I have found that most individual plans (meaning, not ones that you get as an employee), do NOT cover WLS.  Group plans often cover it, but it really is dependent on what the specific company subscribed to, or whether they opted for a specific WLS exclusion.

Sorry I couldn't be of more help.

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

noftessa0401
on 7/9/13 6:50 am - San Diego, CA
RNY on 12/27/12
Topic: RE: what is considered medically necessary?

They don't seem to give a lot of info, do they?  (I just did a quick google search).

You need prior authorization, and it seems to be based on whatever they deem medically necessary.  I would think that a high BMI, such as yours, would qualify.  In fact, some of insurance companies forego the 6-month medically supervised diet if the BMI is higher than 50.

Good luck!

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

Shamira
on 7/9/13 4:41 am - Duluth, GA
Topic: RE: Assurant insurance

i'M LOOKING FOR THIS INFO AS WELL. 

stephaniesjourney
on 7/6/13 12:45 pm
Topic: RE: United Healthcare

I'll definitely keep you updated.  I've got my last psych evaluation on Aug. 6th and am hoping to have my request to submitted and responded to by the end of August....I'm trying to get my hands on my document now too.  I'm hoping its as straight forward as what they've told me...fingers crossed.  If not, I'll just buckle down and start doing the other stuff too....but at least i'll have all this other stuff out of the way too :)  I wish i could find someone that had a similar situation as I do....same BMI, similar background....there's a woman on the boards that's been successful fighting UHC....dont know if she had a dr supervised diet or not in the end but she won appeals etc.....not sure I've got that much energy.....

I'll let you know what I find out :) 

walkingbear36
on 7/6/13 11:54 am - Ferndale, MI
Topic: RE: United Healthcare

oops, forgot to answer your last question - no i haven't started to submit for insurance approval yet because the surgeons office is expecting me to attend 12 months of weight loss and exercise programs. once i've completed that then they will submit all necessary documentation to the insurance company for approval.

walkingbear36
on 7/6/13 11:52 am - Ferndale, MI
Topic: RE: United Healthcare

i called UHC a couple of times and spoke to them and yes, i need a 5 year history of high BMI,  in network doctor, etc. but they said they don't require the documentation of a 12 month diet and exercise plan. i asked that they send me a list of the requirements since it's not on their website and they said i have to acquire that thru my HR department which sounds odd to me.

thanks for your response.

Wany
on 7/6/13 8:01 am - NY
Topic: HEALTHFIRST/MEDICAID NYC

Has anyone had any experience dealing with Healthfirst/Medicaid nyc..... If so what was it like? I'm switching from UHC because they require me to do the 6 months diet And I really don't wanna wait that long. 

stephaniesjourney
on 7/6/13 7:59 am
Topic: RE: United Healthcare

See...they havent mentioned that in my process yet.  When i called and when my drs office called they indicated that i needed 1.  a current bmi of over 40.....2. a 5 year history of a bmi over 40....3.  the dr needs to be in the network (so does the hospital)  4.  have to be over 21 i think....

 

do you work with ING also??  requirements are different b/w companies but i'd think some of the processes would also be the smae.....i dunno.  do you have the other requirements (5 year bmi history etc??)  I can't find the actual information on uhc's website...i would have thought it would be available that way.  I'm really just at the point that I'm going through all my drs requirements so they can actually submit for approval and then we'll see what they say.....

 

have you actually submitted your insurance request yet?? 

ancy89
on 7/5/13 1:44 pm
Topic: Need help

Hi everyone. I'm new here, I'm really happy I found this forum because I have a bunch of questions that I really have no idea how find answers to, so I'm hoping you nice people will be able to help me. I just recently moved to the US, and I'm working and I do have some health insurance but it doesn't really cover anything. I've had a weight problem all my life, and after 10 years of diets I decided to get surgery. I've read a lot about it, about the options, what's available and possible, and now that I've covered that, I'd like to start the process. The problem is that the insurance that I have doesn't cover it. So this is my plea for help. Could you please, tell me, what specific insurance plans DO cover weight loss surgery? I've been going from page to page of the insurance companies but I just can't find anywhere that is simply says what is covered and what is not.

Thank you in advance!

Ancy

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