Do you have insurance that approved the sleeve?

[karaserene1985 1]

Hello,

Some of you may remember me. I was going to have the sleeve done on 4/15 but my lawyer (trustee) wanted me to try and lose the weight on my own instead of spending all that money out of pocket for the surgery.

Since then, I have been trying really hard to eat right and work out. Of course I haven't lost any weight. I've actually gained weight and can't understand it! (No I have not gained muscle b/c my clothes are tighter so I know its fat!)

Anyway... One big stresser was my job! I finally got a new job working for an insurance company so I have excellent benefits now and according to the benefits list, the insurance I picked will cover bariatric surgery 100%!

As soon as I get settled in to the new job, I'm going to start the adventure again and look into the surgery.

I was just wondering if any of you had the surgery in the states and had insurance that covered the sleeve? I know its rare but I really don't want to have any other bariatric surgery other then the sleeve. Its so stupid! I don't understand why its still considered experimental!

Thanks for letting me know!

Kara

[CraftyChristie 62]

From my experience even if it says it covered bariatric surgery, that usually means gastric bypass and MAYBE lap band... the person I talked to told me that the only insurance company in the US that she has heard of covering sleeve is UHC (United Health Care)... this was the woman at my surgeon's office who deals with all the insurance matters.

[karaserene1985 1]

shut up..... I HAVE UNITED HEALTH CARE (UHC)!!!!!

AND....

before I enrolled I had a choice between UHC and Aetna, so I called the surgeons office that I was going to have do my surgery in April and they told me that UHC was IN NETWORK!

That would be so awsome if I could get the SLEEVE and have it covered by insurance!

Has anybody else heard of a different insurance covering the sleeve?

Thanks,

Kara

[CraftyChristie 62]

Wow, you just might be in luck then! I have no idea what the requirements might be. Sounds like it's time for you to give them a call and find out! :drool5: Some insurances require a 6 month doctor supervised diet & exercise program (things like weight watchers dont' count, must be with your dr) before approving any weight loss surgery. But it sounds to me like you have the right insurance company at least! Go get em!

[karaserene1985 1]

:drool5: just waiting on the insurance card to come in the mail!

I sure hope its covered b/c I don't want the lap band or the full bypass!

[CraftyChristie 62]

I totally understand. My insurance would have covered bypass or band (with a 6 month program beforehand) but I just couldn't get on board with either of those procedures.

[tbarnes18 1]

Sorry to be a party pooper, but I have UHC and they didn't for me (and do for some). However, I think my husband's employer can adjust UHC policies and pick what they want to cover. Do they just use UHC to administer? I don't know the answer to that. They would have covered it if I had 5 years of medical records of obesity, which was hard for me because I have hit my weight goal during that time. Plus, my doctor over those 5 years had a lot of problems and quit her practice, twice, without telling her patients. The records that document my weight/weight loss history are no where to be found.

Also, I would have had to be on an exercise/weight loss plan for 6 months.

The hoops were just to much for me. And I didn't want to wait another up to 5 years and then do the 6 month thing because I don't have diabetes, even though the mother and sister do, and I don't want it. I thought time was of the essence for my heath. (Hubby also has diabetes, mainly due to a family history, and I see what he has to go through, i.e., every little medical complaint requires an additional test/lab because the "diabetes could make the medical problem much worse.")

Good luck with your decision!

Terrie

[tbarnes18 1]

Hello,

I was going to have the sleeve done on 4/15 but my lawyer (trustee) wanted me to try and lose the weight on my own instead of spending all that money out of pocket for the surgery.

Forgot to add this one point: I hate to badmouth your trustee, but haven't you tried to 'lose the weight' your whole life? That is a stupid comment by the trustee. I remember when my current doctor's PA told me that my cholesterol was slightly elevated and I needed to control it with changes in my diet or I would need to go on medication. I laughed and told her to pull out the prescription pad because, obviously, to look at me, diet control isn't high on my list...(or completely under my control, for that matter) Stupid people!

[avilda 2]

I have Aetna and they covered it.... was approved in just over 24 hours after submission. If your employer has chosen a plan that includes bariatric surgery that is half the battle. Good luck and keep us posted.

[tbtroy78 0]

I have empire bluecross I was denied at first and approved after appeal from surgeon I was sleeved oinb 4/15 best decision I ever made

[karaserene1985 1]

That's exactly what I told my trustee... that I've tried it several times before on my own and obviously the weight didn't stay off. He said it was still and option in the future, but now that I have insurance that will cover bariatric surgery I hopefully won't need to go to him for a large chunk of money anymore.

My plan description said that bariatric surgery was covered 100% in network for UHC Choice Plus. That is what I chose. Dr. James Kemmerling of GB is also in network and hopefully it will be covered.

[BeenThereWasThat 2]

I have UHC choice plus and my sleeve is covered. I would say that if your policy covers bariatric surgery then your sleeve will be covered. My policy did not specifically state which surgeries were covered but when I got my pre-approval letter my policy covered the 4 major WLS. Honestly if you know your member # I would call 1-888-936-7246 it is the Bariatric Resource Services for UHC they will help you get the ball rolling. If you don't know your number you may be able to call them anyways and have them look it up for you.

Please feel free to PM me and I'll be happy to let you know how the process was for me. I have been approved for about 3 weeks now and am getting sleeved July 13th.

[karaserene1985 1]

Did you have to do a supervised diet or anything? Or did you just submit a request and then got approved right away?

I am just curious how it worked.

[BeenThereWasThat 2]

I didn't but I know other people who have UHC and they had to do the 6 mth diet before approval it really just depends on your policy.

* First thing I had to do was call that number to get everything started they will then set up an appointment for you to meet with your nurse cordinator. Basically they want to make sure that you are serious and that you meet the qualifications (BMI & co-morbitities).

* After you talk to the nurse cordinator she will refer you to UBH (United Behavioral Health) to set up your psych eval and she will verify the WLS that you want to use. They have to be in a "Center of Excellence" or they won't cover the surgery.

* After you've had your psych eval and the surgeon has sent a letter of medical nessicity they will review you for approval

* Once approved you can schedule surgery

Start to finish for me was about 2 1/2 months.... In my opinion the process is kind of slow but it is only because my surgeon's office was really busy and they couldn't get me in any quicker. Insurance approval took 2 days once UHC had everything. I also scheduled my pych eval before I had approval because things were moving too slowly for me.

Sorry for the spelling I am on my phone...

[karaserene1985 1]

Thanks for the info. I can't wait to get my insurance card and get the ball rolling. Right now I'm 313 lbs, and 5'8. My BMI is around 48. I'm 24 years old and don't have any co-morbidities. Do you think that is going to be a problem, or my BMI alone should qualify me for surgery? Hopefully I get approved without a 6 month supervised diet.