Aggie98

Just had to say hi from an Aggie :cursing:

I am using Dr. Marsden too.... just waiting on insurance approval at this point!

Why did you have to have all those additional tests done? I have UHC PPO Plus and they told me that since my BMI was 41.8 that was all I needed to have my consultation and surgery performed. I do have other medical conditons cause from being overweight, but UHC said that the only pre req was that my BMI was over 40. Do you perhaps have an HMO and need the other studies done to get approval? UHC said I did not even need to get a referral from my PCP as that was not required through my policy. Please explain because I am very new to all of this. Thanks:rolleyes:

Absolutely. The other tests that I had done were tests that were required by my surgeon, not UHC. The EKG/Stress Test and sleep Study were done to ensure I was I was medically fit for surgery... additionally the sleep study was done to possibly diagnose sleep apnea which can be listed as a co-morbidity and help me get approved for surgery (I ended up not having sleep apnea.)

The nutritionist and psych eval were done to make sure that I was able to make the changes necessary to be successful with the Lap-Band.

Hope that helps!

Hiya! I have UHC as well. My plan required I be employed with my company at least 2yrs the other requirements were pretty much the same. However, I only had 1 comorbidity-mild obstructive sleep apnea. I didn't have the 5year history-only the last 2 years. I had to write a letter (made it personal not technical) and got approved within a couple of weeks. From what I understand the insurance company wants to make sure that this isn't a sudden weight gain over the last few months and you are doing this to lose it quickly. I believe they just want to make sure it is necessary.

I had my surgery NYEve and it was inpatient. I didn't have a problem getting that authorized either as they submitted everything at once.

Good Luck on your journey..keep us posted!

Cheryl :scared2:

That's great to hear Cheryl! My paperwork was submitted to UHC today and my situation sound pretty much the same as yours. I am also using Dr. Marsden!

I also needed a 5 year history and was missing a year or two in the middle. My insurance told me to just write a letter stating why I didn't go to the doctor that year and what my weight was those years. So you might ask if a letter would be ok. I have also heard of some people submitting photos to sub for the weight history.

Good luck Maggie! I also have UHC and my doctor should be submitting to my insurance today or tomorrow. Hopefully I will be approved!

Thanks for all your replies!

I am not generally an overly sensitive person or someone that needs to be coddled all the time but her attitude really IS frustrating. I just feel like if she felt like my circumstances would make me unlikely to be approved, maybe she should have told me this BEFORE I spent money doing everything on my end to get ready for the surgery. Oh well, I will just keep plugging along and hope that I get approved! Several people at my job have had the surgery and all had an easy time getting approved with varying circumstances with their health. Hopefully it will be the same for me!

My paperwork should be submitted to my insurance company either tomorrow or Tuesday and I am feeling kind of discouraged because of the patient advocate at my surgeon's office.

My insurance (UHC Choice Plus) requires a BMI of 40, and weight history for the last five years, and if you don't have the 40 BMI, you have to have 35 plus two comorbidities. At my initial consult I had a BMI of 40.5 and over the last five years I don't have a 40 BMI but it has definitely been over 35. Fortunately I don't have any health problems but I know if I keep down this road I will definitely develop problems.

Anyway, the woman at my surgeon's office keeps telling me that my insurance is probably going to deny it, and is always asking me if I still want to submit my paperwork. I've heard that UHC is one of the easier insurance companies to get approval from, and I think I have a pretty good chance. Besides that, I have already spend quite a bit of money on co-pays for the surgery requirements so I want to follow through.

Is she just trying to get me to not get my hopes up or what? She has been so bad that at a couple of points during the last couple of weeks I was ready to just say "Screw it! I will just join Weight Watchers again...." Is what she is doing normal?

Thanks for your input!

I ate a HUGE lunch before my initial appointment at the surgeon's office. I was still just under, so the medical tech had me weigh again with my coat and purse on! Bingo... 40.5 BMI!

I have UHC Choice Plus, and all that is required of me is 40+ BMI or 35-39 BMI with 2 co-morbidities, and 5 year weight history from my doctor.

I hope to have everything submitted to UHC this coming week. I have heard that they are one of the easier insurances to get approved, and they are usually pretty quick in making a decision. We'll see!

Good luck!

Congrats on getting approved Juls! I hope I don't have any problems. I complete everything I need to do on my end this Friday, and my PCP should be sending my records over late this week or early next week and they will submit to insurance. I hope I hear back pretty quickly!

Glad everything is going to well for you!

Did you have to pay the $1700 before the surgery or did your doctor bill you for it?

Good luck! I had my initial consultation today too. My BMI was 40.5, and they just have to get my records from the past 5 years and submit to my insurance. I hope I am approved!

Hi everyone!

I went to my first appointment today and found out my insurance requirements (I have United Healthcare Choice Plus) -- 40 BMI or 35-39 BMI with two comorbidities, and 5 year health history with 40 BMI. Today when I weighed I was at 40.5, and I know I was not that high through the last 5 years, although I am sure I was above 35.

The only comorbidity I have is hypertension although they told me the insurance might not count it b/c I am not on meds. I am scheduled for a sleep study which might diagnose me with sleep apnea.

Anyone think I have any chance of getting my insurance to approve? Thanks!