UHC - Now Approves VSG!!!!!

[Bambi 0]

Hi Little - where did you find that information? I just went on the Oxford Health Plan (OXHP dot com) website and under Medical and Administrative Policies, clicked on Bariatric and found the following:

Due to insufficient clinical evidence to support medical efficacy, the following will not be reimbursed by Oxford:

• Gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch
  

[LittleLadySky 0]

I had actually called them and for the information I was given, the lady said yes. I also saw it in the newspaper. I will do a research later on and will PM you the info.

[excited2lose 0]

I have UHC and was approved last week for the sleeve! I am thrilled!

[LittleLadySky 0]

congratulations..those are great news, so do you have a surgery date already. I am at the final steps myself, so hopefully next month I will be able to get a date to submit my stuff to insurance

[excited2lose 0]

My surgery is going to be Jan 25th! I am so excited!

[Stacie 1]

I have UHC and I was approved in the beginning of December. I did not need 6 months supervised diet. The only requirement for me was a 5 year weight history.

I hope that other insurance companies quickly follow suit.

[shylady318 0]

I have UHC here in Texas and my doctor will be submitting it for approval on Monday. I can not wait. They said they are the easiest to get approval. I sure hope so. I finally decided on a doctor now I just want to get started. I will keep you posted.

[ibc32oz 0]

I have a question for someone more knowledgable than I. I have been working on getting approved for the vsg for 6 months. UHC is the company, and I've talked to them 5 or 6 times over the phone. Went to the Dr., had the psych eval, sleep studies. Have a 38 bmi and diagnosed sleep apnea. Well, when all of the paperwork was submitted, they denied. The reason is that you need to be above 40bmi, and no other requirements. Apparently they don't approve on the 35-39.9 with a co-morbidity diagnosis. Haven't done an appeal. When an account supervisor returned my call, she advised that their tool that they use was wrong, and that's why for 6 months their customer service people were giving bad advice. I have requested a policy back in order to read for myself, but if it's true, is there any chance for an appeal? Bummed out about this, as in addition to the severe sleep apnea, have Plantar Fasciitis on both feet. Been getting treatments for 2 years, and last hope is surgery. Podiatrist says that it's from weight, so vsg could have solved weight, apnea, feet, etc. Please advise if you have any suggestions or experience like this. Thanks.

[thinoneday 445]

I have UHC as well, but in my case it was that my employer did not opt to add bariatric surgery onto the insurance, so it wasn't covered, neither is any cosmetic surgeries. . soooo, i ended up being self pay, which was alot better anyhow. . . i got a bank loan at 3.7% for the full amount and had my surgery in no time flat. . . no loop holes, no hoops to jump, nothing, just show the money and your on your way. . . good luck and hope all turns out well for you. . . .

[ibc32oz 0]

Hey, Thinoneday, that's great news that you were able to get it done. What did it end up costing you for the sleeve? I've been reading all over the net lately, and wondering if it's a consideration to have it done in Mexico. We'll see what happens. I'm hoping to hear, though, that someone has successfully argued against the bmi of 40 rule.

[shylady318 0]

I have UHC and I got approved. I first got denied because the doctor's office did not send the pysh eval with it, just an error on their part but after they did that it was approved in a day or two. I am scheduled to go see the doctor this Thursday. I can not wait hopefully by the end of this month I will be on the other side.

My UHC requirements were 6 months diet, which I had already done before I knew that, BMI Over 40, pych eval and one of more co-morbidity, which i have high blood pressure and sleep apnea.

It really depends on the employeer they set the conditions and whether are not they will cover it.

[schatzie 0]

I have UHC, I was 40 BMI, and some comorbities. I was approved and they alredy reembursed me, it was overseas.

[thinoneday 445]

Hey, Thinoneday, that's great news that you were able to get it done. What did it end up costing you for the sleeve? I've been reading all over the net lately, and wondering if it's a consideration to have it done in Mexico. We'll see what happens. I'm hoping to hear, though, that someone has successfully argued against the bmi of 40 rule.

Hi there, I think my surgery was an excellant price considering it pays for the surgeons (2), anesthesiologist, hospital stay (3 days) 1 year follow up care (monthly), nutritionists, psych, after care 24 hours anytime, and all this for $15,500. The hospital was a very prestine private hospital, very personal and caring only 10 beds limited for bariatric care only. . .there even was a separate area for your loved ones if they were staying in your room with you, yup their own "room" . . shared bathroom of course with you. . .and the best part of all, i got to stay in my own city with the confidence of knowing that the healthcare was here if i needed it. . . good luck in your considerations and best to you in your decisions. . .

[tomandlu 0]

I had VSG surgery 11/3, UHC approved. BMI between 35 and 40 w/diabetes, sleep apnea, hypertension. UHC's medical policy is available on the web - PM me with your email address and I will send it to you if you can't find it. The issue may be in what they define as a 'co-morbidity'. Good luck!

[tomandlu 0]

... Have a 38 bmi and diagnosed sleep apnea. Well, when all of the paperwork was submitted, they denied. The reason is that you need to be above 40bmi, and no other requirements. Apparently they don't approve on the 35-39.9 with a co-morbidity diagnosis. QUOTE]

This may be the reason: From the UHC medical policy on bariatric surgery -

Bariatric surgery is proven for the following:

1. Class III obese (BMI > 40 kg/m2)

2. Class II obese (BMI 35-39.9 kg/m2) in the presence of one or more of the following comorbidities:

? Type 2 diabetes

? Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris, hypertension or coronary artery bypass)

? Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy)