Confused :(

[lovealways 22]

Need some clarification, please! So I called my insurance company (united healthcare community plan) and they said they only cover gastric bypass. I wanted the sleeve. I heard that some surgeons are able to actually get the sleeve covered, but it is a little bit of extra work. Is this just wishful thinking?

Also, I had my first consultation with my surgeon. So far, no one knows if I need a 6 month supervised diet since the patient advocate was out on vacation. I called my insurance 900 times and they said they don't see anything about a 6 month diet and that the only requirement is pre-auth. Should I go ahead and assume I don't need it or just go ahead and do the 6 months anyway??

Ahhhhhh. So frustrating! Thank you!!!! :)

[tarakuk 6]

If the insurance company says your plan does not require a 6 month diet, it's not required. I wouldn't be surprised if they didn't cover the sleeve though, especially since it's kind of new. Your patient advocate will be able to find out more. I did have to do the 6 month diet with my Blue Cross Blue Shield, and then it took another 10 days for the authorization after that...not too bad. Good luck to you!

[ready4change79 26]

Try to get the code for insurance from your doctor and call back with that. I have united healthcare choice plus which I know is different but it may help to have the code...good luck. I will keep my fingers crossed.

[Wheetsin 714]

The code is CPT 43775: Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy).

Generally if something is not covered by your insurance, a surgeon will not be able to get it approved. It would be like only buying liability coverage and then asking nicely to have your car fixed, too. Well, not exactly, but kind of.

If a 6 month diet is not listed as a requirement, it's not required. Call and reference the CPT code and procedure name I included above. Tell them you need to know the full requirements. Better yet, if you have web access to your coverage, pull it up and see what it lists.

I wouldn't do the 6 months if it's not required. You'll get much better results from 6 sleeved months than 6 supervised diet months.

HTH

[ready4change79 26]

I did not have a 6 month diet either with uhc.

[kjntwins 59]

You can appeal it. You will have to have your dr on board to do the extra paperwork. It really has to be due to a medical reason why you can't have the bypass done. My surgeon was ready to go bat for me, but just last week my insurance started to pay for the sleeve. But I could not have the bypass done due to medical problems, it would have been very unsafe for me. Where as the sleeve would not been a problem.

[lovealways 22]

Thanks so much for the help, guys. This forum has been so, so reliable and helpful.

I'm not even sure where I heard that if VSG is not covered by insurance, and only gastric bypass, then an insurance company would make an exception fo the sleeve based on medical necessity. Either I dreamed it, or something, because I don't know where I read or heard that! hahah. Like I said, wishful thinking. At this point, I know I would consider gastric bypass since VSG is not covered. I would hate to have to go through the process of appealing, etc.

So if I call my insurance company and give them the code they would be able to better assist me in seeing if VSG is covered? So far, two reps I've spoken to said only the gastric bypass.

Does anyone know if there is a forum like verticalsleevetalk for gastric bypass patients? =/

[Wheetsin 714]

Alex (the guy who owns/runs this forum) has boards set up for the major bariatric procedures. So the sister to this site is http://www.rnytalk.com/

[pkehrer 79]

I have UHC also, and didn't have to do a 6 month program. All three procedures were covered under my policy, so I hope they can do it for you! If not I think appealing it couldn't hurt!

[lovealways 22]

I have UHC also' date=' and didn't have to do a 6 month program. All three procedures were covered under my policy, so I hope they can do it for you! If not I think appealing it couldn't hurt![/quote']

Hmm that's really good all 3 are covered for you. I don't see why my UHC would only cover just one procedure =\

[mufasas-mom 170]

I have UHC and had to do the 6 month diet - but it's all ok. It also cover all 3 WLS. You'll have to check with your employers website for medical benefits to see what's covered. UHC has lots of policies and within that each employer chooses what to cover. best bet - do NOT trust the doctors office, but do your own legwork and call you insurance and ask to speak with a bariatric specialist.

good luck to you.

[former_vbg 198]

Hmm that's really good all 3 are covered for you. I don't see why my UHC would only cover just one procedure =\

I'm assuming your insurance is through your employer and that means that your employer gets to customize the plan. Often if you find you have less coverage than someone else with the same insurance company its because your company wanted to cut costs and that might be an area they chose to do so.

Find out from the insurance company what they do or don't cover using the CPT code given above and then you should be able to get a straight answer.