Sunbunny064
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3 years has passed since you registered at LapBandTalk! Happy 3rd Anniversary Sunbunny064!
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Thank you,
I am so stressed out by the wait for the insurance approval. My BMI is only 38 but I have 2-3 of the comorbidities. Do you think the lapband is worth the fight? I am almost ready to just give up.
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I am overwhelmed by the vast range of differences for every person who gets this surgery done. As if the nightmare of waiting to hear back from the insurance company is not stressful enough, then you have to pay program fees on top of it all. I hope it is worth all this. I am waiting for my insurance company to make a decision. My surgery is scheduled for 2/18.
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Yes I am banded, YesI had United healthcare insurance at the time. Also, I do bariatiric insurance approvals for a living and deal with UHC on a daily basis. I posted United Healthcares requirements which you can find on their website under the medical policies section. An employer group may put different requirements on the policy but the UHC requirements are pretty standard. I find in Texas where I practice the percentage of UHC plans that follow the standard requirements is about 98%.
Kathy
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If every insurance policy is different, how can you post the requirements UHC will accept with such certainty? Do you have UHC? Are you banded?
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Congratulations! My summary plan description does not say a thing about 5 years of history. All it says is that there must be a medical necessity in order for morbid obesity to be covered. I am not morbidly obese yet, my BMI is only 38. But if they deny me don't think I won't put on that extra 10 pounds that will bring my BMI to 40! If the insurance company denies me, I will file an appeal because I have hypertension, hyperlipidemiam, non insulin dependent diabetes just to name a few. Having this surgery could save my life. I have done every diet known to man and even taken prescription diet pills. Everything goes ok until I go off the pills and then the pounds return with their cousins. Insurance companies only care about the cost associated with the proceedure. I wish they had to live in my body!
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United Healthcare is a PPO, it is illegal for your doctor to charge you a dime other than your co-pay prior to billing your insurance first. You are smart to question this practice.
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I have United Healthcare. I received a letter today asking for all the medical records to substantiate what my surgeon had listed in his pre-authorizaion summary. They did not ask for 5 years or say I needed any specific BMI. All the letter asked for was medical records supporting my diagnoses, including all lab reports and physician's notes. They asked for a list of medications I am taking. The letter said they will attempt to expidite my request but it can take up to 45 days. My surgery is scheduled for 2/18/09 so they had better hurry. I am going to take this response from my insurance company as a postive step towards my surgery.
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February Dates for Banding
Sunbunny064 replied to JulsJourney's topic in Tell Your Weight Loss Surgery Story
Hi, I have United Healthcare Plus and I have a surgeon that is in network. I too have been at this process for about 8 months now. The doc sent my info to the insurance company on 1/23/09. I confirmed they received it and it is scheduled for review on 1/26/09. I don't have my approval letter back yet. My sister works for the hospital where I am going to have the proceedure done and she said I am on the roster to have surgery on 2/18/09 @ 10:30am. So, I am crossing my fingers the doctors office knows something I do not. -
Hey Banster Bunnies, I just received word today that my surgeon has sent my file to the insurance company for a pre-authorization. Cross your fingers for me, I might be a February Bunny! I can handle being Miss February some day. (ha ha) Now that I think about it, I would be happy to just be able to fit into a pair of Levis.
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I'll keep my fingers crossed for a quick insurance approval! I hope it goes as quickly and smoothly for you as it did for me!
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Hi Misty,
I have the same insurance you do with UMR being my third party administrator. My doctor is sending everything over this week in hopes of getting me approved. I have done a 6 month visit. Your post has given me hope that they will approve it. Thank you!
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Hey Gabi,
Don't give up, believe it or not if you get a copy of the AETNA requirements from your insurance policy or your HR department, AETNA can be pretty good to work with. They are sticklers about the 6 consecutive months of office visits with your doctor, if you miss one month they will deny you and you will have to start over.
