United Healthcare Choice Plus VSG approval?

I went through the 6 month weigh in for Anthem Bluecross of California for bariactric surgery however upon more research i preferr to go through the VSG as oppose to RNY. Now my husbands medical is due to change January 2011 to United Healthcare Choice Plus - i've called and spoken to 2 reps to find out about approval for the VSG and have been unsuccessful and have also gone to the website with no luck there as well, I have seen on on several searches that United does approve the VSG but when trying to verify this information with UHC they will not verify this info.  Has anyone recently been approved for the VSG in California through UHC Choice Plus? Will I have to go back through 6 months of weigh in and can I tranfer this information over to UHC?

 All policies are different, of course, because employers can opt in and out of the various procedures, requirements, etc. That said my UHC Choice Plus did approve the sleeve at a 40 bmi with no co-morbidities or a 35 bmi with 2.  I required a 24 hour hospital stay, 5 year history and documented failures of other diets (this was literally just listing them all). 

Thanks dragonflydiva - do you know if criteria differ for each state? Congrats on your VSG surgery and current weight loss!!

 Thanks!  And I think it depends much more on your employer than your state. BTW... My UHC online doesn't mention WLS at all. Neither did my paperwork. I called and asked a rep specifically.

Totally correct -- UHC ChoicePlus is great, BUT it is completely up to the employer which procedures the employer chooses to support. You can find out from the emplyer's HR rep if bariatric surgery is covered. If it is, then you can go online to your UHC website and look to see if bariatric is covered and what its requirements are. If you don't find it there's a phone number there and you can talk to a UHC rep and they'll tell you.
I had to go on a six-month MD-supervised diet program, supply evidence of failed weight loss programs, attend informational meetings on VSG, and get a bunch of labs and reports (nutritionist, psych eval, cardio, etc.) It can take a while to get it all together, but you can do it. Once everything is turned in it can take from three days to a month to hear back from them. If they deny, you can appeal. If they deny the appeal, you can appeal to the state board of insurance. So it's totally possible to get approved and have it covered -- it's just not going to happen overnight. You can do it -- lots of others have. Good luck!

I had to self-pay with UHC.  5 year history wasn't sufficient

Completely agree with the posters who pointed out that the employers can opt in or out of certain coverages, including bariatric surgery. Luckily, my husband's employer opted in and the 3 WLS that were covered under our specific plan was Band, RNY and the Sleeve. My UHC case manager said that the sleeve was new *just* this year.

I had to do the 6 month required monitoring (our plan stipulated that it was to be a MD, RN or a licsenced nutritionist or dietician) plus all the other requirements like labs, pulmonary, psych eval, EKG, etc.

I also recomend talking to your husband's employer to find out if their package includes coverage for WLS, and try calling UHC again.

Under *my* personal plan, I would say that YES all of your 6 month weigh-ins that you completed for BCBS would count, provided that you have documentation and it was an MD, RN or dietician. I'm so happy with my sleeve, I can't imagine having a Band or RNY, truly this in my opinion is the best WLS available today!

I have UHC Choice Plus (in NY) and my surgery was fully covered as my employer has opted in. I had to provide 6mo. weight/diet history documented with a PCP. My letter mentioned past failed diet attempts as well as my comormidities (sleep apnea, chronic migraine, borderline high cholesterol). I had to see a psych, NUT and upper GI prior to insurance approval as well. However, it did take about 3 weeks from submission time before I was approved (my surgeon said UHC was backed up...but they schedule surgery before they submit so it wasn't that big of a deal).

I would think you should be able to transfer your 6mo. of weight history over, but all of these insurance companies have so many rules. Good luck!

Thank you all so much for your post this information is very helpful. I have the 6mos, 5 yr. diet history, met the nutrisitionist, and psych eval. just hope that will transfer over to UHC and that - i've just contacted the hr rep for my husbands company and they couldn't let me know if the VSG is approved by their company or not (that was interesting)!

I have UHC EPO Choice and got approved for VSG (after some hassle). My requirements were similar to yours (6 month nutritionist appts, lots of tests, psych eval, 5 yr history). For me, they tried to deny me based on missing paperwork (that THEY lost) but the generic denial letter they sent out was super vague. Thankfully, my surgeon called their medical director and straightened it out for me so it was overturned within a week and approved. Just keep an eye on them and if they shut you down, investigate and get your surgeon's office to assist. Also, UCH screwed up some billing stuff for a lot of my (very expensive) tests. I eventually got it fixed, but if I had not done the legwork they would have been after me for thousands of dollars I shouldn't have paid. Gotta love insurance companies

edit to add: Also make sure you INSIST they fax/mail out anything you will later need (ie: someone saying something IS covered/requirements/etc) in writing. With me, different reps told different stories so I found out the hard way I really needed to request whatever they told me to also be CC'ed my way in writing after the conversation. That way, you can fight them later if they change their tune.