Approval Seems A Bit Too Easy.

[tsteves1 14]

So I talked to a woman at the resource center and she said that I qualify even though I don't have a co-morbidity because my BMI is over 40. She also said there is no 6 months diet plan, just your typical evaluations like psych and such and I could probably have the surgery here is the next few months. She has scheduled a phone meeting with me and a case worker at the resource center for next week 1/12 at 11 to get everything rolling. She is also sending me information on the surgical center I am required to go through and told me I could research their surgeons and pick the one that I want. It also looks like I may only have to pay 3k OOP rather than the 6 I was originally expecting. Seems the only thing I have to do is keep my BMI at 40+ until everything is confirmed which is not a problem as I cant seem to get any of the weight off anyway.

Point is, this seems too simple to really be true. I would love some input from people on this. I would like to hear from people that were told it was this easy to get this approved and it turned into a nightmare as well as people who really did have such an easy process in the beginning. I'm trying to not get too excited yet but the hope is building and I can finally start to see the possibility of a new and better me.

By the was my insurance is United Healthcare and my plan is a Choice Plus HRA through Wells Fargo.

[brownie012 1]

My mom has hers through united, but she had to have a ton of stuff...all the things u said u didnt. Im on bcbs and the criteria are fairly simple for my insurance to cover it as well. Proof of wt for at least 2 yrs, no throid disorder, letter of necessity from pcp, psych eval. Surgeon requires scope to check beforehand for ulcers and psych eva. My oop is 1300. Im curious to see what experiences others have had as well...good luck!

[Scooterbug 13]

My wife and I are about to meet with the Labband surgeon on the 18th of this month. We also have United Health Care handled by UMR, and have the UHC Options PPO plan. Our deductable is 3000.

Initially my wife was told through her HR department that the requirments were just a BMI greater then 40 (35 with co-mobitities). We checked with her HR department twice once with a rep and once with a supervisor, and they both confirmed this. On Jan 3rd we called to UMR to check with them and find out the requirments. The rep at UMR stated the only requirment was to be 100lbs overweight.

On the 4th our surgeons office called UMR and she was told 100lbs overweight and a 6 month supervised diet. After hearing about this from the surgeons office my wife called UMR and was told we only need to be 100lbs overweight.

I dedcied to call after my wife did. I made the rep call to whatever department she had to and get the "propper" information. I was advised that the requirments were 6 Month supervised diet, 100lbs overweight and 40 BMI or higher.The rep said those were requirments straight from United Health Care. The rep also stated that when you call and talk to them, the reps only have basic information (trying to explain why we were told 100lbs overweight and not the correct info)

Needless to say I was annoyed..not at the fact that we have to do the 6 month diet, but at the fact that they kept changing there stories.

Personally i would call 3 or 4 times to verify exactly what you need, better yet see if you can get it in writing or have them email you a copy of the policy where it states what you need. Better to make sure then get ready for surgery THAN find out you need a 6 month diet.

[xavier 153]

Well I hope it is that simple for you. I have heard a few people for whom it was like that! What is the $3000 for if it is 'covered'?

[Scooterbug 13]

I know with my insurance the 3000.00 is the deductable. Once the deductable is met UHC/UMR covers everything 90%

[tym4me 206]

With my healrh ins. I had to do 6 months weight management 2 nutrition visits a phys visit and have a bmi of 40. What to do in this case is to always get it in writing. Call the ins. company ask for the specifications for this procedure and to send them to you. But be careful usually if its to good to be true it....

[tsteves1 14]

They cover 80% after I pay my 2K deductible and my OOP max is 4k. My company gives me 1k to put toward it and count toward my OOP max so I only have to pay 3k OOP.

[SueQueRN 5]

I used UHC - my doc sent my records to the surgeon - had a psych and PT evals. That was it...easy peasy! BMI 35% with comorbidities

[FIL 0]

Every insurance company has different criteria. Your Surgeon's office should know the ins and outs of what's required for your insurance company. They should also get with them early and determine exactly what is required. In my case, Aetna, I had to do 3 mos Dr. monitored weight loss (that was a joke), Psych eval (3 hour questionaire, what a pain in the ass), and cardio workup. It probably helped that I had high blood pressure and had been diagnosed with sleep Apnea the year before.

It seemed like a lot of hoops to jump through, but it's been well worth it. I have a flexible spending account as part of my benefit package. I was able to spread my OOP ($2,500) over each check pre-tax...GREAT BENEFIT!

Good luck to you!

[rn2012 6]

Every Insurance is different and the plan your employer picks within that company is different. I have aetna, and i had to do a 3month supervised diet, cardio workup, endoscopy, pysch eval, overnight sleep study and no deductible. You should go on your insurance company website and look up weight loss surgery requirements and it should be there in black and white, i know at least for Aetna it was under their policies on their site

[tsteves1 14]

Thanks all for the information and advice.

This is information that my insurance company gave. When you call/go online for my insurance company they refer you to the Optum Health resource center to get information and start the process. The lady at the resource center was very specific in telling me that there are no supervised diet requirements, just a psych eval and a BMI of 40+ or a BMI of 35+ with co-morbidity. She actually sounded very surprised and told me that my company had picked a great plan.

The only reason that I doubt what she is saying is my own pre-conceived notion that insurance companies say one thing and then do another. I do believe she may be sending it to me in writing in the next few days, if not I will definitely request that they do. Seeing your responses really helped me feel more comfortable though.

[tsteves1 14]

My rep sent me the requirements for my insurance in writing which is great. I now have a major concern though. She sent me a list of surgeons and website where I can view their requirements. I read that they will want a letter of medial necessity from my Primary Care physician and I do not have one. I have always gone straight to the Dr that I know can fix the issue. For my PsuedoTumor Cerebri I have a neurologist, for my fertility problems I have an OBGYN, for my back problems a chiro. I have never went to a primary care physician for my weight because my neurologist said they would just subscribe pills and told me to do WW, which I did many times as well as the HCG diet and many other fad/crash diets. I can get a Primary care physician if they want just hoping this doeskin derail me.

[Violet953 46]

I don't feel like typing my whole story for the millionth time right now but you can find posts from me talking about the different issues I've had with my insurance and surgeons office....its been a year long process and now I'm FINALLY just waiting on approval....it may sound like its gonna be easy as you type the steps out but its never that easy....there will be bumps on the road no matter what...and think of it as more time to get yourself mentally prepared for this...because that's what it did for me. There may be people out there who got lucky with not having to do all of these steps and good for them but often times it will be lots of waiting and hoping. Good luck with everything!

[Scooterbug 13]

My rep sent me the requirements for my insurance in writing which is great. I now have a major concern though. She sent me a list of surgeons and website where I can view their requirements. I read that they will want a letter of medial necessity from my Primary Care physician and I do not have one. I have always gone straight to the Dr that I know can fix the issue. For my PsuedoTumor Cerebri I have a neurologist, for my fertility problems I have an OBGYN, for my back problems a chiro. I have never went to a primary care physician for my weight because my neurologist said they would just subscribe pills and told me to do WW, which I did many times as well as the HCG diet and many other fad/crash diets. I can get a Primary care physician if they want just hoping this doeskin derail me.

I had the same issue with needed a letter of medical necessity from a PCP. We moved from South Carolina to Florida at the beginning of this year so neither me nor my wife had one. We told our surgeons office about that, and they said not to worry. They told us to do our first appointment with them (surgeons office) then they would get us an appointment with a PCP that they work with all the time and they would get the letter, physical, and everything else taken care of.

[kymie9899 37]

I Have United Health Care HRA Choice Plus through Novartis and began in Oct. Went to nutritionist, counselor eval, hospital preop. Submitted letter for approval and had approval in about a week. Going in Monday for Surgery. UHC has many different programs but I've heard and found that it's a good one to work with. I've called and received a million different answers but my surgeon's office has had no problems at all and said it's the best one. It can be just that easy, I think unfortunately you tend to hear the horror stories more than the positive ones. Congratulations and good luck on your journey!