Newbie questions

[LovinLife 0]

Hello! I am in Houston, Texas and going for my doctor consultation on June 10th. I've learned that my insurance company will cover the Sleeve (United Healthcare/AT&T plan). The insurance company needs 5 years of doctor records showing I have been overweight for this length of time. I actually haven't been good about going to the doctor at all for the last several years. Has anyone had this requirement and received approval without the 5 years of weight "proof"? Do morbidities assist in this case? This week I was diagnosed with severe sleep apnea. Thanks for any feedback you can offer!

[eriadne 6]

I was missing a few years due to my doctor's office losing some records as well as me not going to the doctor. They only need one weight from each year, any doctor will do. I wound up with weights for 2009, 2006, 2005. None for 2008 and 2007. I was approved with no problems by Aetna.

It would have been physically impossible for me to have lost any significant weight in the missing years and gain it back to wind up weighing what I do know. I also have a a comorbidity (sleep apnea) and my BMI was well over 40 at every point from 2005 onwards. Also, my surgeon's office does nothing but weight loss surgeries, so his staff has the insurance approval process down pat. I have no doubts that they advocated for me like crazy.

I was 100% positive I'd get rejected and have to wait to get my weight history (I am a horrible pessimist sometimes!) but my husband was 100% sure I'd be approved. I think you will only run into a problem if your BMI was or is borderline low for their criteria.

Even if you get rejected, you can always appeal their decision. Many people have appealed their weight loss surgery denials successfully with a personal letter describing your weight struggles and medical history, pictures of you (at your worst & most heart-wrenching, I suppose ) and showing them why it would be a good idea for them to invest in your health with this surgery as opposed to just paying out for you to see doctor after doctor and have your health decline.

Self-pay is of course another option if all others fail. But as a rotten grumpy pessimist who's been there, I've got faith that you'll get your approval! Best wishes! :thumbdown:

[LovinLife 0]

Thank you lotusflwr80! And good luck to you on your upcoming surgery!

[kensom235 0]

I have united health care also. and was wondering how long after you submitted your info did you get approved. I have all of my weights for 5 years and have done 7 of my 10 phone conference with my wellness coach. and I have high blood pressure and border line diabetes, with a family history of high blood pressure and diabetes and heart problems. SO you think I would will have any trouble getting approved, and should it take a long time.

[ImReady 0]

Hello! I am in Houston, Texas and going for my doctor consultation on June 10th. I've learned that my insurance company will cover the Sleeve (United Healthcare/AT&T plan). The insurance company needs 5 years of doctor records showing I have been overweight for this length of time. I actually haven't been good about going to the doctor at all for the last several years. Has anyone had this requirement and received approval without the 5 years of weight "proof"? Do morbidities assist in this case? This week I was diagnosed with severe sleep apnea. Thanks for any feedback you can offer!

I had this same question last week and got some wonderful responses. I have only been to the Dr in 2009, before that it was almost 7 years ago. I plan on sending dated photos for each year, a letter from my PCP, who while I was not a patient, did see me multiple times when I brought in my kids over the last 5 years and my beginning weight from my last pregnancy almost seven years ago. If you have been to the gynecologist that would work. Also, for my insurance at least, it seems like this is something that the insurance coordinator can choose to let be a problem, or not. So my advice is to get as chummy as possible with your insurance coordinator. I am on month 2 of my six month physician supervised diet so I don't have any real info, but these are the ideas I plan to use. Hope it helps and good luck.

[LovinLife 0]

kensom235 - I should clarify that while my United Healthcare plan will pay for sleeve surgeries, I have not submitted for insurance approval yet. My consultation is June 10th and then the insurance process will begin. I will let you know how it goes!

[Lillie24 2]

Keep in mind that even a yearly women exam takes your weight. Or going to the emergency room, or an urgent care center. Anywhere that took your weight. Even if you had a gym membership. Anything along these lines helps with the requirement and could be pushed on the insurance co. to use. They are just needing something to say that you were overweight.

[Bonne M 0]

My GP has advised me that I am a very healthy fat smoker. My labs are normal, except for that I am boarderline diabetic. I go to the dr....never. I don't get sick (I don't have time for it) I have been between 260-320 for 5.5 years. I am still waiting for UHC to approve. I have gallrocks. I am afraid they won't and will approve me.

[Bklyn Lady 0]

Yes, I have the same insurance....my doctor did write a letter but the insurance company had already approved me before they received his letter....I had co morbidites, i.e, hypertension, documented sleep apnea, BMI 41...it's not that I went for a physical every year but they would weigh me even if I went in for a sinus infection, so they did have enough years of weights....you might too. Best of luck.

[Nene16 0]

Hi. I'm Nene and I am also from Houston with United healthcar insurance. I am in my 4th month and I expect to be rejected as well with all my health conditions. I did use a local non profit agency that is assiting in gathering all the required data which then submit my informaiton. I have had some disappointments with the whole process, but I'm sticking to it for now. I'm figuring I will have surgery in September. Reading the books listed here in this forum to help me understand, learn and acuire new tips to be ready for this life changing event. Good Luck.

[jerryvic 3]

BonnieM

There is no such thing as a "very healthy fat smoker", especially when you have gallstones and pre-diabetes. Get real. Being overweight is not healthy. Smoking is not healthy. Pre-diabetes is not healthy. Gallstones are not healthy. If these were healthy things there would be no reason for anyone to be getting this surgery. Please don't fool yourself, get the surgery, quit the smoking and then say you are healthier!

[dixienms 24]

Ok here goes. This is my first post and after reading all the answers above some of my questions have been answered. I have been to the seminar that the surgeon requires, and the insurance advocate (guess thats what she is called) has told me that UHC does approve the gastric sleeve surgery however, I have to have documentation of 2 years doctor visits with weight loss being the main reason for visits. I have been dealing with my weight for over 5 years, and my PCP doesnt document each diet I have tried. She did write a letter saying she knew I was on the diets and how much I have lost but nothing in my records. My sleep apnea doctor did write a letter stating how aggressively I have tried to lose weight in 2 years, only achieving 21 pounds and that the surgery would benefit my health tremendously since I have obstructive sleep apnea and other health problems. So after stating all this, does anyone know if United Health Care will accept what my doctors have sent or will I have to do something else for them to say go ahead. Its like I am approved but Im not approved kinda.

[JaniRN 5]

Who will be ur Dr?

[JaniRN 5]

Who will be ur Dr?

[dixienms 24]

Who will be ur Dr?

Dr. King in Oxford will be my doctor, if you are asking me.