Mab 44 Posted March 16, 2012 My paperwork for VSG was submitted last week and I am a nervous wreck. I can't focus on ANYTHING. I have Generalized Anxiety Disorder (with a "specialty") in catastrophic thinking, so I'm always thinking the worst. I need a reality check, which is why I've come to you all! Below are the requirements for obesity surgery with United Healthcare under AT&T's plan. I meet all of them. Yet, I can't help thinking that they are going to deny me. Covered Person must have a minimum BMI of 40; • Covered Person must have documentation of a diagnosis of morbid obesity for a minimum of five (5) years from a Physician; • Covered Person must be 18 years or older; and • Surgery must be performed at a Network or ONA-PPO Provider by a Network or ONA-PPO surgeon. This is true even if there are no Network or ONA-PPO Providers near the Covered Person. • Benefits are limited to one procedure during the entire period of time you are covered under AT&T Medical. My current BMI is 42, I am diabetic and I have sleep apnea. Even though co-morbidities are not mentioned below, would they be taken into consideration? Thanks for any words/thoughts/whatever you have for me. Share this post Link to post Share on other sites
ProudGrammy 8,322 Posted March 16, 2012 My paperwork for VSG was submitted last week and I am a nervous wreck. I can't focus on ANYTHING. I have Generalized Anxiety Disorder (with a "specialty") in catastrophic thinking, so I'm always thinking the worst. I need a reality check, which is why I've come to you all! Below are the requirements for obesity surgery with United Healthcare under AT&T's plan. I meet all of them. Yet, I can't help thinking that they are going to deny me. Covered Person must have a minimum BMI of 40; • Covered Person must have documentation of a diagnosis of morbid obesity for a minimum of five (5) years from a Physician; • Covered Person must be 18 years or older; and • Surgery must be performed at a Network or ONA-PPO Provider by a Network or ONA-PPO surgeon. This is true even if there are no Network or ONA-PPO Providers near the Covered Person. • Benefits are limited to one procedure during the entire period of time you are covered under AT&T Medical. My current BMI is 42, I am diabetic and I have sleep apnea. Even though co-morbidities are not mentioned below, would they be taken into consideration? Thanks for any words/thoughts/whatever you have for me. hi you have a double edged sword. 1. good for you, with all your morbities, weight, diabetes you should pass for the insurance, so try not to fret. 2. bad for you, with all your morbities, weight, diabetes - you have all these problems that will qualify you. - you should pass qualifying you for the insurance and the projected sleeve - which we all are here for and the end results, so i think having #2 is good for this situation. good luck best kathy Share this post Link to post Share on other sites
2bfit 62 Posted March 16, 2012 UHC is pretty easy to qualify with. You should be a-ok! I qualified and I had UHC H M O. No comorbs and a BMI of 42. I was denied at first but I appealed. DO NOT GIVE UP! Fingers crossed! Good luck! Share this post Link to post Share on other sites
newme2b 5 Posted March 16, 2012 You have ATT and they're paying?? Can I ask what state you live in? I have them and they're denying me in GA'. Thanks in advance. Share this post Link to post Share on other sites
Mab 44 Posted March 16, 2012 You have ATT and they're paying?? Can I ask what state you live in? I have them and they're denying me in GA'. Thanks in advance. I literally JUST found out that I was approved. My husband works for AT&T (management/non-union) and we have United Healthcare Choice Plus-Definity. I am in Georgia. I switched to his insurance specifically for obesity surgery as the plan I was under at work (State Health) dropped WLS as of this year. What are your stats and the specific name of the plan you are under? Share this post Link to post Share on other sites
newme2b 5 Posted March 17, 2012 I work for ATT management in GA but I have Kaiser. They said no way to me! And I have comorbitities and a bmi of 40! Share this post Link to post Share on other sites
Mab 44 Posted March 17, 2012 I work for ATT management in GA but I have Kaiser. They said no way to me! And I have comorbitities and a bmi of 40! Maybe it's a Kaiser thing? I chose our plan specifically because it covered the surgery. You can always change providers during open enrollment in November. If I hadn't been approved, I was headed to Mexico. Share this post Link to post Share on other sites
newme2b 5 Posted March 17, 2012 I'm headed to MX April 10. We should stay in touch and compare experiences! Share this post Link to post Share on other sites
Mab 44 Posted March 25, 2012 I'm headed to MX April 10. We should stay in touch and compare experiences! Just now seeing this - Yes, absolutely. And what a coincidence - my surgery is set for April 10th!!! I start my liquid diet next week and I am not looking forward to it. Ugh. Share this post Link to post Share on other sites
BigCraig 87 Posted March 25, 2012 I'm headed to MX April 10. We should stay in touch and compare experiences! I don't know if it will help, but UHC also turned me down after 2 appeals and supported by the VA ins commission, we went to my HR rep and got it approved, but it did take just over a year. Not with AT&T though, FWIW Share this post Link to post Share on other sites
dixienms 24 Posted April 17, 2012 I too am waiting to hear if UHC approves my request. Insurance coordinator said takes about 2 wks and it's been one week now. My BMI is 42, I have obstructive sleep apnea , diabetes, dysfunctional thyroid and although my PCP NEVER recorded my diet attempts, she did write a letter( hoping that's just as good). My sleep doctor also added that for the sake of my health and life I seriously needed the surgery. It's driving me nuts waiting but I keep telling myself "no news is good news" . Lord I hope I hear something positive soon from my surgeon. Share this post Link to post Share on other sites