Maryland Obamacare: Anyone Successful in Getting WLS Surgery? Employer plan doesn't...

Hello All,

I currently have health insurance through my husband's policy, but it excludes ALL weight loss surgery, regardless of medical need. From what I Have researched, Maryland is one of the 23 states that requires Obamacare Insurance Marketplace plans to cover WLS for those who qualify.

It looks as though I could choose from a United Health Care, Cigna, Kaiser, or Carefirst plan. Which one seems best for getting an APPROVAL?

Thanks for any and all advice!

I am not sure that anyone will be able to answer that completely. Each provider may have a slightly different set of conditions you have to meet to qualify for WLS. It's not so much the insurance provider as it is the plan that you have with the provider.

Are you meeting most of the qualifiers that people post about here? BMI over 40? Or 35-39 with comorbities (high bp, sleep apnea, arthritis)?

If you meet those qualifiers. Then there will be other things probably. Like I had to go through 6 months of supervised visits with my surgeon and the nutritionist there. Some plans only require 3 months. Some none. And like most I had to pass the psych evaluation.

If your plan covers WLS and you get through these kinds of things then you will most likely be approved for surgery. Some of it also depends on your surgeon and if he thinks you are ready.

You really need to check out the details of each plan. See if any of them have requirements that you don't feel are reasonable or you will be able to complete.

For no particular reason other than I have been covered by both companies I would probably check UHC or Carefirst. Then move on if you don't like those.

Good Luck!

Hi Jazzycatz,

Thanks for the information. Which insurance covered your VSG?

Also, I read that Aetna DID AWAY with the weight loss surgery 6 month diet requirement. I would think that most insurers have similar things--aka the rules are the same for all people in the insurance, regardless of actual plan?

I've read that United Healthcare fights hard to DENY people much needed WLS. I'm at a BMI over 40 with sleep apnea.

I had zero issues getting United Healthcare to cover my wls.

May I ask, was that through Medicaid or through a private insurance policy? Also, which state, and did they require all the six months documentation, etc?

It was through private insurance from my employer in PA. I had to provide 6 months of documentation but it didn't have to be consecutive months. It had to be within the past two years. UHC also had a form to record the 6 month supervised diet from my pcp.

I'm on my husband's plan with Kaiser & have been very happy with the program they have here in the Atlanta area. There's an orientation meeting where you learn about your options, meet the doctors & go over what's required of you. If you choose to go forward, you meet with a nutritionist & therapist, meet with the surgeon & go through pre-surgical testing & afterwards there are follow-up meetings with your surgeon (2 wks, 2 months, 6 months & 1 yr, after that I don't know)& the nutrtitionist (approx every 2-3 months). I think the process, from the orientation till surgery took about 6 months.