So Afraid On Not Being Approved

[Pana'sNewStart 68]

Hi guys,

I'm brand new to the forum and i figured this would be a great place to get support. I am meeting with the surgeon for the first time on Thursday (in 2 days!!) and then I'll find out whether or not UHC will approve me for surgery. There's no reason why they wouldn't: 5-year weight history, Pyschiatric evaluation, medical clearance, PCOS, 6 month Weight Watchers... I'm just so nervous, though. I think because I don't have high blood pressure or anything like that. I'm just tired of being fat and being addicted to food. I want so badly to change my life with the band. I've been working on this since March and now I finally get to meet with the surgeon. I'm right there!

I have United Health Care and there a lot of people I work with who have had either the lap bad, gastric, or the sleeve so it seems like the insurance covers it fairly regularly. I understand that it could 2 weeks to get an approval. Anyone else have UHC? Any words of encouragement?

Thanks in advance for your support,

Pana

[Allen J. Oh 7]

I don't have UHC, but it seems to me that in the past few years it has gotten easier to get covered. My wife had WLS (not banding, though) four years ago, and she had to jump through a lot of hoops to get coverage. Several people in her support group had to go through the appeals process. For me, going through the coverage process now, it seems more routine.

As for the timing, it really depends on the insurance company. My surgeon's office said that two weeks sounds about right for my company (Blue Cross/Blue Shield of Minnesota). You don't necessarily need to have a comorbid condition (like hypertension) to qualify -- again, this depends on your insurance company, but basically having comorbidities helps you qualify for WLS at a lower BMI. My insurance company, for example, would not cover my surgery if I didn't have comorbidities because my BMI is about 36, but since I have hypertension, diabetes, and sleep apnea, I do qualify. If I didn't have these, I'd need a BMI of 40 to qualify for insurance coverage.

In any case, it sounds like you've already gone through a lot of the hoops, so it should be pretty straightforward from here. I know how nervewracking it can be to wait for the news re: insurance approval, but hang in there and trust that you've done all you can to move the process along.

[jen_1381 446]

I have UHC. It depends on your plan as to what they cover. They cover, as a general rule, BMI over 35 with two co-morbidities, or BMI over 40. I can't say it was easy with insurance; my doc thought it would be no problem so at my pre-op they scheduled surgery for 10 days later. Two days before surgery, UHC came through with a denial because my doc submitted "hypertension" instead of "uncontrolled hypertension". He had to go to bat for me, calling and getting an immediate review conference with a Medical Necessity rep. Luckily, they overturned their decision and approved it with 5 minutes to spare.

One thing that caught my attention that you said in your post - - you don't want to be fat and addicted to food. Just be aware that the band does not stop your cravings, addictions, or the food you put in your mouth. It simply helps you feel more full with less food, and stay full for longer periods of time. It's been a blessing for me, and 5 months out I'm still learning how to work with it, and my changing body, but it is truly a lifesaver.

[Pana'sNewStart 68]

Thank you guys so much! I've had BMI over 40 for 5 years, so it's not required that I have a comorbidity. I've talked with people I know who have had the lap band and they say it really does help with the cravings, though, you're right, it won't take them away. I'm so happy to have found this forum

[hollyelbert 14]

I did not have any other health conditions and I was approved. I don't have united health though. My approval process took 6 months.

[honk 780]

Personally I would'nt say it helps with "cravings" like ice cream or Cookies. I still occationally "crave" these things. For me the band helps me feel satiated and not interested in eating for 4-5 hours. I can walk by a plate of cookies an hour after lunch and not pick one up. Preband I would never have done that.