United Healthcare ***

[2bfit 62]

Hello all! I am new to this site. I was originally signed up with the lap band forum. I finally had my appt with the surgeon today. I went in thinking Lapband and came out thinking gastric sleeve.

My surgeon has submitted the request for the sleeve. So now I am waiting to see if my insurance will approve the surgery. I have United HealthCare *** which allows for bariatric surgery if it is deemed medically necessary. Which I would think would be obvious if the surgeon is requesting it. Only thing I am wondering now is if they will cover the sleeve. I originally was so focused on the band that I never researched the insurance process for the sleeve. Is it different? According to the insurance there is no specification on a "procedure" other than the medical necessity portion. I have met with the nutritionist already and I know I will have to submit to a psych eval. I fulfilled the diet requirement because I was under a medically supervised diet for 2 years plus I had records for 5 years of a gym membership. Other than that I feel like I am starting all over again. Is there anyone out there who has had a similar experience? Switching from the band to the sleeve midstream? Any information would be appreciated. It was such a struggle just to get the approval to see the surgeon so the fact that I made it into his office after months of trying was a definite plus. So at this point the sleeve is now my first option and if that's not covered the surgeon is going to submit for the lapband. If you have a sleeve I would love to hear about your experience. Any information is appreciated!

[ldydrgnkpr 49]

I have UHC and I originally started the process wanting lap band. Once I went to the seminar I quickly changed my mind to VSG. I called UHC and spoke with my coordinator about how I have changed my mind and I would like to have the sleeve instead. Her only concern was if I was switching doctors. I did not have any problems with getting my sleeve. Have you called and spoke with a coordinator? Good luck with everything!

Deb

[2bfit 62]

I have UHC and I originally started the process wanting lap band. Once I went to the seminar I quickly changed my mind to VSG. I called UHC and spoke with my coordinator about how I have changed my mind and I would like to have the sleeve instead. Her only concern was if I was switching doctors. I did not have any problems with getting my sleeve. Have you called and spoke with a coordinator? Good luck with everything!

Deb

[2bfit 62]

Hi Deb! Thanks for responding! At this point I don't even know if I have a coordinator yet. I contacted United Healthcare 3 times. Yep, 3! The first person I spoke to told me I did not have bariatric coverage! I told her she had better check again because I just saw the surgeon. The customer service people need some serious training. The only thing they could tell me was that bariatric surgery is a covered benefit if it is deemed medically necessary. So now I am just waiting for the authorization from my medical group to approve the surgery and all the pretesting I will need. I think because my visit with the surgeon was for the initial consult only I won't have a problem going with the sleeve so long as the insurance covers that procedure. I verified with the medical group that the surgeon is requesting the sleeve. So as of right now I am sitting and waiting which seems to be the hardest part! I did see on the asmbs.org website that United Healthcare is covering the sleeve. Hope they are right.

Can you tell me a little bit about your experience with the sleeve? Any tips? How do you like it? Does it really take away the hunger?

[M2G 1,836]

I have UHC and was originally going for the band. My case manager was the one who spelled out the 3 types that MY plan covered: RNY, Sleeve or Band. I had never heard of the sleeve. Even after going to the surgeon's seminar, I was still planning band. Then my hubby wanted to join me (I was about 3 months into my 6 month required supervised "diet") and he didn't like the sound of the band. Begged me to research the sleeve and I did switch mid-stream from band to sleeve. Same surgeon, he never blinked was totally fine with choice because it was my decision.

I had not yet submitted to insurance (as I was still in the process of the 6 month supervision) so the surgeon's office changed all the paperwork to be sleeve and I moved foward. I'm now almost a year post-op and am soooooooooooo happy I don't have the band. One surgery and you are done. My hubby is now also sleeved and we both love it. We did both lose our hunger but not every VSGer does, so beware.

Also please don't have surgery thinking you will never again have to "diet"...you will have to work your sleeve giving the proper amount of Protein, Vitamins, Water and don't forget you will need to exercise. It's not easy but it is SO worth the effort.

In my personal opinion the band should be marketed as TEMPORARY. Very few people have the same band for 10 years or more, especially without trouble. The is erosion of the stomach tissue, band slippage, vomiting, acid reflux, port trouble and there are TONS of people who get bands and either have them taken out or revised ot a different surgery. Even my surgeon's nurse had a band for 5 years and it slipped and she revised to the RNY. She was the surgeon's nurse and was a perfect bandster...there is just too many things that can go wrong with a band. With the sleeve, once you are healed you are done worrying about future problems (at least I was!) Do your research but if you can get the sleeve, I would recommend it over any other type of WLS. You have to do your part and of course the sleeve won't prevent you from eating cheesecake, Cookies, ice cream and all the junk food in the world, that part has to come from you. You choose to eat healthy and have a healthier life so that you can battle the obesity monster. The sleeve is a great tool but you have to use it properly. Good luck to you on your journey!

[2bfit 62]

Thank you for the information. I am happy that I have decided to request the sleeve. I should hopefully know by next week if I am approved for surgery.

I actually started my weight loss journey in 2005. Since then I have lost about 40lbs on my own but I have hit a wall and have not been able to lose anything for the past couple of years. I made a commitment to lose weight and be healthier. I take supplements and I do exercise and even with all of that I could not lose another pound. It has been very discouraging to say the least. I still could not control my portions. I learned that you can still overeat even if you are eating healthy.

Then there was a ray of sunshine when I started to research the band a couple of years ago. I am glad I waited to pursue WLS because now the sleeve is open as an option for me. The thought of having a foreign body inside of me and getting poked to fill or unfill was not very appealing. I was also afraid of slippage and having things get stuck. I want something permanent. Something I can learn to use as a permanent tool to get on with a healthier life. If all goes well with my surgery my husband will be having it too. Which I think will be great because then we will both be committed to a healthier lifestyle as a family. After reading more about the revisions people have had I KNOW I made the right decision with the sleeve.

The surgeon reviewed the 3 options available to me and let me decide. Though he wouldn't say anything because it had to be my choice, I think he prefers the sleeve as well.

Anyway, I will keep you all posted once I find out what happens with the insurance this week and what they require.

[2bfit 62]

Ok so the drama begins...again. I just called the medical group this morning and they denied me for surgery. They are stating that I do not meet the obesity requirements and that I have to have one comorbidity to qualify with a BMI of 35-39.9, that I have to consult with a registered dietician and enroll in their weight management program. Almost sounds like a standard denial letter that they send out no matter what. I called the surgeon's office and am waiting for a call back from the nurse. They have all of the records from all of the plans that I have already tried. Maybe they did not send them in with the request?

I have written an appeal letter. First off, I have a BMI of 40 and per the policy requirements no comorbidity is needed. Second, I have already had the consult with the dietician who agrees that I would be a good candidate for bariatric surgery. Third, I went to a medically supervised weight clinic for two years, belonged to a gym for 5 years and most recently tried the HCG diet.

Along with the letter I am submitting all of these records directly to the insurance company. I did call to make an appt with their weight clinic. I will jump through as many hoops as they require. I can't give up on this and I will not go away without a fight!

I am feeling so discouraged right now though. I know it's the practice of the insurance company to deny everything. But still I am hopeful that I will win. Any words of encouragement or wisdom would be greatly appreciated.

Thanks,

Cheri