UHC

[amberj 21]

Hi everyone! my names Amber and i'm currently in the process of getting this thing started. I have already met with my surgeon, today in fact. I sat down with the woman who takes care of insurance and i got up a little confused. I asked her at least 5 times how much the actual procedure was going to cost and I never got a real answer. I have united heath care through Target and they pay 80% after i meet my deductible ( which is almost met). I know insurance companies negotiate prices with doctors so it makes it difficult for me to find out how much im actually going to have to pay. I'm pretty sure she said for just the doctors fee, without insurance, is 9000, that doesn't include the hospital. How much could that be since its done as an outpatient surgery? I called the insurance company to find out but they need the code and of course i don't have it. i am int he process of getting an appointment for a psych eval and after those results come back i can get with the surgeon for a surgery date. I guess i just need to be patient. I was just wondering if anyone had an estimate of how much it actually cost for the procedure

The only requirements for approval is >40 BMI and older than 18--seems easy enough

[slp98 0]

My surgeon had a discounted cash price of about $18,500 for a gastric sleeve, including 1 night hospital stay, anesthesiology, a GI test post-op, and surgical assistant. I have not heard of the surgery being outpatient (I had to stay 2 nights) so I don't know how that might affect the price, but I would not expect anything under 15,000.

[M2G 1,836]

I also had UHC with a high-deductible plan. After shelling out $5K my plan pays 90% and I pay 10%. I think you are going to find it hard to get an exact number PRIOR to surgery. There are many fees associated with the surgery. There is the dr. fee, hospital fee, I also had a separate fee for my leak test, and a separate fee for a surgical assistant. Oh there was also a fee for the pathology report on the portion of my stomach removed (I think they just generally test it out to make sure there is nothing wrong with it, etc.) So I can't tell you how much I paid unless I wanted to sift through all my bills and add them up. I do know that the actual surgery was over $32,000 BILLED to insurance and then there was of course the "discounts" through insurance and no one actually paid that amount. My portion ended up being very small because I hit my deductible.

Also beware that going through insurance means that you almost always will have some type of waiting period. Mine was 6 months of required check-ins with a nurse, dr. or registered dietician before getting approved. If you miss a month you are back to square one. I did all my NUT counseling through my surgeon's office so they would have all the proper notes required to be submitted and approved.

Good luck it is worth the wait to save the money if your insurance covers it!!!

[amberj 21]

thanks for responding I think i have about 500 left on my deductible. i have about 4000 left for my maximum deductible. After that, the insurance pays 100% of all cost. So that gives me a lot of hope! I've talked to my insurance agency and ask about the 6 month diet thing because i had read so many stories on here about having to have the diet but the representative said i didn't need anything but a bmi over 40 and have it deemed clinically necessary by a physician. I'm hoping that doesn't change on me. The surgeon said it was done as an outpatient procedure in a local hospital. I thought i'd have to stay in the hospital a couple of days but I'm not sure. The surgeons office gave me a list of doctors but said i could go to anyone for the evaluation. I'm just waiting to get an appointment. I called several and left messages. Since most my deductible is met already i want to have this done before the new policy year rolls around because my original deductible is 3600.I don't want to have to pay that again. I have high hopes! this seems to be my last resort. I've tried so many diets, jsut to lose weight and gain what i lost plus 10-15 pounds more each time. having kids didn't help much either. but they are my driving force right now. I want to be able to play with them without getting tired or take them to the beach because as of now i'm too ashamed to wear a bathing suit. I just want to live and being overweight and self conscience about it is keeping me from being happy. All of you that have had this and have had success with it are such an inspiration to me. i keep looking at before and after stories/pics and cant help but wonder if that'll be me in a couple of years. it makes me want it even more!

Congrats on your weightless! I can't weight to be where you are !!!

[ab76307 22]

I also have UHC and my out of pocket is 2K. UHC pays 80% and I pay 20%. I only had like $200 out off pocket this year so I had to pay about $1800. Call your insurance company and see what your out of pocket is. If it is 2K like mine and you have it done within this year then you will only be out the balance of the out of pocket if your UHC plan is like mine.

[M2G 1,836]

Were you assigned a "case manager" I had two. I had a case manager - the person who answered all my questions and could look up specifics on MY policy and give me yes or no answers, and a nurse case manager - the one who all the paperwork was submitted to and she was the SOLE decider of whether or not I was approved. My case manager was much more accessible than my nurse case manager.

When I made the inital call to my UHC insurance and spoke with someone concerning having WLS, I also wasn't told about the 6 month diet....but that was the FIRST of many calls, it wasn't until I was assigned a case manager and moved forward that I was told about the 6 month diet. So initially all I needed to move forward was the BMI over 40 (or 35+co-morbs)... so just beware that you may not be getting the whole picture just yet. Not to burst your bubble or give you bad news, but I felt totally defeated when they told me it would take 6 months. Now of course I would do it again in a heartbeat, even if it meant more $$ by going into the next year because the sleeve was worth every red cent I paid for it.

Your plan I'm sure is different from mine and maybe you don't have to do a 3 or 6 month supervision diet, but most of them do have some type of requirement like that. Don't forget there is also all of the tests, cardiac, pulmonary, blood tests, physch eval, etc. It sounds as if you are planning on having surgery this year and I obviously don't know the details of your plan, but if you are at the very beginning, just be prepared that having surgery may take a while. It may not happen this year.

Best of luck to you on your journey and PM me if you have questions because I miss a lot on here...soon you will be where I am, but be prepared for things to take a while. Hang in there!

[M2G 1,836]

Oh I forgot, my plan stipulated that my surgery had to be at a Bariatric Center for Excellence surgery site...and it was not outpatient, although I have heard that some VSG procedures are. I spent one night in the hospital and was released the next morning.

[2bfit 62]

I have heard that if you have already been on a medically supervised weight loss plan for more than 6 months, that those records are ok to submit to satisfy the 6 month supervised diet criteria. Is this true? Does anybody have any input on this?

[2bfit 62]

So here's a question. How many years to you have to show that your BMI was 40 or over? I dipped below to 38-39 a couple of times while dieting over the past 4 years. But I always regained and went back to my original BMI of 41.

[amberj 21]

quick update:::: my paperwork was submitted last Friday and i got the call today saying i was approved! as of now surgery date is November 16th !! WHOOP WHOOP! I couldnt believe it got approved that fast with no complications what so ever! it had made my day 10x's better!!!

[2bfit 62]

Congratulations! BIg happy dance for you! What a way to start the weekend!

I just contacted my case manager and the nurse is still reviewing my appeal. This is so frustrating.I sent in my 6 month diet, gym membership, NIH guidelines and the written guidelines as outlined in my evidence of coverage. I just wish they would hurry up already! But I have an H M O so I guess I have more hoops to jump through. My BMI is 41 with no qual comorbs. I was told I would have an answer no later than 11-9-11. Feels like a lifetime! I started this process back in July!

[amberj 21]

oh my goodness!!! that does seem like a long time. I got really lucky i guess. I just started this month. however, my bmi is 51. a lot higher than yours. the only thing the nurse requested was my bmi, height and weight and the attempt is made to lose weight. I lucked out of having to do a 6 month diet, but then again I just had a baby and had gestational diabetes and with that came a diet plan so maybe that counted for something. I feel blessed to have had this go through quickly. i was so afraid that i'd get denied and wouldn't be able to have it before my insurance year was over. i have a 3600 deductible ( very high!) and i just didn't want to have to pay that again. My doctors office has been amazing through the process. the financial adviser there told me to not call the insurance company and just let her handle it. i had called and they said itd take two weeks and they'd need a diet and a 5 year record, but that was standard procedure i guess. I was told its a case by case thing.

I really hope you get big approved come the 9th!!! fingers crossed!!! if you're anything like me, you need this!