Cristay30

New to the forum and find it very helpful! I've been thinking about getting the Lapband for the past three months. I finally went to a seminar to see what are the first steps needed to start the process. I called my insurance company (United Healthcare) and found out that they do cover the surgery with the normal guidelines. At the seminar I found out my BMI was 54, I have no co-morbidity and that with my age I was a very good candidate for the surgery. The question I have is.....that most of the weight lost surgery programs here in Ohio want you to pay a program fee. Some starting at $300...$500...even up to $800 non-refundable fee, and has to be paid before they will even submit to your insurance for pre-authorization. I'm not too sure in just giving up this money and not knowing for sure if my insurance will approve it. What should I do?

I have UHC Choice Plus. I had the surgery done on May 20th. Checking my claims online just to see how much I would be paying with my co-insurance and it shows the total hospital bill it self was paid but the surgeons claim was denied. I was denied saying I don't have coverage for weight loss surgery under my plan....which is not true since I got the pre-approval on April 17th. So now I'm fighting it out with UHC.

I finally got in to have my Psyc. eval. I told him about the weight loss surgery...why I wanted to have it....told him a couple of my fat girl stories(I've been heavy all my life so I have ALOT of them). All said and done he tells me to come back next week. :tea: I thought it just took one visit. Am I going to have to see him for a month or so just to get the ok? Or does he see something else??? Please let me know what the normal timeframe is to get the ok. Thanks!!!

I wanted to say thank you to everyone on this forum. :confused::laugh::tt1::laugh:I have UHC Choice Plus, my paperwork was submitted on Apr. 8 and was approved on the 17th. I just received my official approval letter in the mail today. :rolleyes2: So we'll see how long it takes the surgeons office to call me to setup my surgery date. This forum was very helpful to me!!! I just lucked up on it one late night doing a search on the LB. Those who are still trying to get approved....KEEP AT IT, DON'T GIVE UP!!!! :cry_smile:

Well today I got my surgery date. May 14th....they wanted to give me May 7th but I got scared and chickened out of that date. :smile: But this new one I will stick with. So I have to start the pre-op diet next week. I've already planned my last meals out. :lol:

Ok this is where I'm at. I finally got the approval from the psychologist and he faxed over the letter. I finally got a call from the surgeons office(first and only in 2 months since I started the whole process) to let me know that they have received the letter and that they did have at least 3 yrs of medical history from my PCP. They still need 2 more yrs but I know for a fact I have one covered but have to dig deep for the other. So I'm all happy I'm close to having them send off to get the approval. She says well you know UHC is now having people do the 6 month supvr diet?!? WTF???? So of course I hang up and call UHC the first call they send me to a care nurse. She advised me to just have the surgeons office to just send through what they have. I kept asking what all the requirements are and she just said your doctor has to diagnose you as being morbidly obese. Just have them send your name, age, and weight. :thumbup: If it was that easy you think I would be going through all these hoops???? So now I'm really confused on what to do. I know my insurance covers the surgery but to be this easy is a joke right?

I've heard this. My surgeon told me that UHC will cover the surgery but not the fills after. I called UHC myself and they said ya your employers policy does cover the surgery itself but not any fills after that. I asked why and the UHC agent said I don't know but to me it makes no sense either. He stated that the office visits will be covered but not the fill itself, for that you will have to pay out of pocket. So my surgeon is charging $100 per fill and from what I heard it could take 4-8 fills to hit the "sweet spot". So I've started saving money for fills.

SUPER MAJOR VENT IN 5.......4.......3......2........1! I'm about to scream! I finally got the approval from my psychologist to proceed with the surgery. He told me he faxed over the papers on monday. I called today just to check and make sure things were in order and see if it's been submitted to UHC. First I was put on hold for 10 mins while she searched for the fax.:Dancing_biggrin: No they don't have it. I told her who it was faxed to...she says oh maybe it's in the pile on her desk and by the way she's not in today.....:Dancing_sad: So she tells me to call back tomorrow. But before she hangs up she tells me oh by the way we still need your 5 yrs medical history. I told her it had been faxed over 3 weeks ago. (I made sure my PCP faxed it that day and I called 2 weeks ago to make sure it was received.) She then says....Oh they only sent us one year of medical history.:Dancing_biggrin::cursing::Dancing_biggrin::cursing: And you didn't call me within these 2 weeks to tell me this???? I had to hang up before I lost it. Why oh why did I pay a program fee if I'm the one doing all the damn work?:Dancing_biggrin: This has been going on from day one. I've read all the horror stories about others going through this and now I get to experience it myself. Sorry people...that was a super vent! I had to let it out before I took it out on the innocent. :Dancing_biggrin:

Ok this is where I'm at. I finally got the approval from the psychologist and he faxed over the letter. I finally got a call from the surgeons office(first and only in 2 months since I started the whole process) to let me know that they have received the letter and that they did have at least 3 yrs of medical history from my PCP. They still need 2 more yrs but I know for a fact I have one covered but have to dig deep for the other. So I'm all happy I'm close to having them send off to get the approval. She says well you know UHC is now having people do the 6 month supvr diet?!? WTF????:tt2: So of course I hang up and call UHC the first call they send me to a care nurse. She advised me to just have the surgeons office to just send through what they have. I kept asking what all the requirements are and she just said your doctor has to diagnose you as being morbidly obese. Just have them send your name, age, and weight. :thumbup: If it was that easy you think I would be going through all these hoops???? So now I'm really confused on what to do. I know my insurance covers the surgery but to be this easy is a joke right?

Thanks everyone for the input! Hey bandmeplz, I think I will take the advice and check into Dr. Schumacher. Dayton is about 30 mins from me....so that's close enough for me to check it out. Also what all did you submitt to Dr. Curry to get the ok and how long did it take?