UHC - Now Approves VSG!!!!!

[ibc32oz 0]

Well, I finally got a hold of the actual policy that my company has with UHC. It is true that you can only be approved of the sleeve (or any of the wls) if you are over 40bmi for the last 5 years. I wonder if anyone has successfully appealed while having less than 40 ( mine is 38). I guess the co-morbidity of severe sleep apnea no longer matters. Anyone?

[longhorn 11]

Well, I finally got a hold of the actual policy that my company has with UHC. It is true that you can only be approved of the sleeve (or any of the wls) if you are over 40bmi for the last 5 years. I wonder if anyone has successfully appealed while having less than 40 ( mine is 38). I guess the co-morbidity of severe sleep apnea no longer matters. Anyone?

ibc32oz,

I don't think this is as much a UHC issue. It does come down to the specifics of your policy and the language used to describe what is covered. You can always try an appeal. But I found that process with UHC to be slow, frustrating, and unproductive. Besides, your policy does not seem to cover you as described. Regardless of if someone else has successfully appealed or not, it comes down to what your policy covers for you. It does not sound promising. Sorry about that and hope I am wrong. You can always try speaking with someone in your benefits group at work to see if they might be aware of any exceptions.

It always does seem odd that these policies can sometimes actually encourage you to gain weight in order to get the coverage for the surgery you need. I'm not recommending that at all. But it does cross the mind I imagine. Your policy seems to require 5 years at > 40 BMI. So that is no bargain for sure.

Good luck to you on figuring out your options.

longhorn

[wannapar 0]

I am in the begining stages of working on getting an approval from UHC for the Gastric Sleeve. They are requiring 5 years of medical records. I really haven't gone to the doctor much in the past 5 years. I did a sleep study in 2006 and was diagnosed with severe sleep apnea. My BMI then was 41 and is now 45 and I still have sleep apnea. My question is if I can't produce any medical records for the complete 5 years, because I didn't even go to a Dr. for a couple of the year, do you think they'll turn me down. I'd appreciate your feed back. Thanks for the informations. I am really excited about the opportunity to start a more healthy life and really don't want to have to shell out the $15,000 if I don't have to. Thanks.

[ibc32oz 0]

My understanding is that the 5 year history is very important if the insurance company requires it. I also don't go to the dr. very often. I had to talk with my wife concerning visits over the last 5 years. My current bariatric surgeon had seen me in December, and again in January. That right there sufficed for 2 years. I the went back to a ER visit, and a couple of dr's that I'd visited for little things like a back ache, or sport injury. I called several of them, and asked if they had information. Several of them had my stats of the appointment, and sent into the bariatric surgeon. I even called a Care Now (not sure if you have them where you are) and they had a couple of years info. I'd gone to the Care Now when having a small work injury, and for poison ivy or strep throat, and sure enough they had taken my height and weight. It may seem challenging now, but discuss with a spouse or parent....spend some time recalling where you've been over the past 5 years, and you'll get it. Well worth the time to find it, right? Good luck.

[Spaz80 0]

I'm glad I found this thread. I'm currently pre-op and deciding between the VSG and Lap Band. I have UHC and will have to go check what my employer opted for but I think we have WLS. I'm currently in my six month program with my surgeon's office since it is required of UHC. Five year history of weight will be easy too if they need it. I'm just glad to see that UHC is approving in cases since I wasn't sure. I am leaning more towards the VSG and will be getting more information at my next meeting with my dietary program.

[Margoboo 0]

I am soooooo disappointed!!!!! I was denied for wls! I have a 42bmi, and 3 years charted with a bmi over 40. The other two years, I was on diet pills, which is also on record. They denied me........................................................................................I am soooo up-set! I have sleep apnea and probably pre-diabetic. They say I must wait 2 more years............................ I am going to fight this!

[Cmstant 0]

Has anyone had to deal with a revsiion... I had the Lap Band in 2005, whcih had slipped and now given the option between the Sleeve or another Band. I decided the Sleeve and it is going to the insurance (UHC). Just curios if I would have to go thru the evals. for the revision?

[educationrulz 18]

Have you tried to see if you have any other comorbidities? Often there are health issues that we've been dealing with for years and just thinking of as a fact of life, when in fact they could help our cause.

For instance, do you have knee/joint pain when going up and down stairs? If so, go to your PCP or an ortho and get xrays. They'll probably find some arthritis related to extra weight. Also, get your cholesterol level checked. If it's high, this is considered a comorbidity. Back pain? High BP?

Get a comprehensive list of recognized comorbidities from the insurance co. and put your head together with your PCP and I'll bet you can come up with something to win the appeal! You will probably need a strong letter from the PCP along with proof of the comorbidities but I bet you have a chance.

Good luck!

I am soooooo disappointed!!!!! I was denied for wls! I have a 42bmi, and 3 years charted with a bmi over 40. The other two years, I was on diet pills, which is also on record. They denied me........................................................................................I am soooo up-set! I have sleep apnea and probably pre-diabetic. They say I must wait 2 more years............................ I am going to fight this!

[kkandrod 1]

Anyone here with UHC through Shell Exploration and Production Co? I called the insurance company and gave them the code for the VSG, it came up partial gastrectomy, not VSG and she had my member ID and stuff so I assume she was looking at the correct policy info in regards to what Shell has set up with them. She said that was an approved procedure with medical notes. But, then when I asked if there were any other histories like weight or anything like that needed she said no but if it was for weight loss that would be a completely different story and code. So, I'm like totally confused, LOL

I have heard from others with BMI's lower than 40 that PCOS is considered a co-morbidity, anyone know if thats true???

[valleygirl806 0]

I have UHC through my husbands job, it used to be UMR and I had to call the INS co many times for clarification...I would suggest you keep calling untill you are satisfied with the information....that's what customer service is there for.