LBD 121 Posted August 22, 2013 Ugh, so sorry to hear that! It's infuriating because providing WLS would probably benefit them in the long run. Makes no sense. With my plan, I do have coverage, but we have a maximum out of pocket of $3,000 per person. I'm guessing I'm pretty close to that with all of the preoperative stuff I've done over the past couple of weeks. If they called me with an "oops, we were wrong" I might just lose my lunch!!! Best of luck to you with all of this, I hope somehow this becomes viable to you, hernia or not. Share this post Link to post Share on other sites
melissa1104 5 Posted August 23, 2013 thank you! me, too Share this post Link to post Share on other sites
nervousnelly 24 Posted August 27, 2013 What do you mean it is up to the employer? I have Oxford United Healthcare. I had to hump through hoops and wait 6 months but I did and am scheduled for today.... But I don't understand... Are you saying the insurance will tell my employer? Share this post Link to post Share on other sites
melissa1104 5 Posted August 27, 2013 What do you mean it is up to the employer? I have Oxford United Healthcare. I had to hump through hoops and wait 6 months but I did and am scheduled for today.... But I don't understand... Are you saying the insurance will tell my employer? she just told me to ask my job to add it in the plan Share this post Link to post Share on other sites
Mommie4 53 Posted August 27, 2013 I have united also, high option. Its my husbands insurance through his employer. the employer accepts weight loss surgery on their insurance so I was excited to hear that. I was confused when I first started all this too. The employer has to have it as an option on the insurance and they can have specifications too. Mine is BMI of 40 or higher with no comorbidities or if it under 40 then you have to have 2 comorbidities (health issues) check what they are because they are all different depending on insurance. My insurance does not require a diet before surgery, however, I do have to have a 5yr obese weight history documented by doctor appts, weight watchers or anything that shows at least one weight for each year proving I was over weight for 5yrs prior to this...ugh its a mess but just keep fighting! Share this post Link to post Share on other sites
beauty29 72 Posted September 2, 2013 There are many different plans available through UHC plus. I have completed my 6 months and recently gotten approved. Just waiting for docs office to contact me and get me scheduled in. Optum health is great they work to get you approved. Share this post Link to post Share on other sites
melissa1104 5 Posted September 4, 2013 Yeah i'm basically out of luck..the united health care wont help me...sooo i'm considered self pay...the surgery is 11,800 but i'm going in a few weeks to be put to sleep and check for any hernias if i have one (which i actually hope i do) my price will be knocked down to 6,000...keeping my fingers crossed Share this post Link to post Share on other sites
beauty29 72 Posted September 5, 2013 I'm just waiting to find out about my hospital financial responsibility Share this post Link to post Share on other sites
beauty29 72 Posted September 5, 2013 I hope every thing works out for you Melissa and it will... Share this post Link to post Share on other sites
Mommie4 53 Posted September 5, 2013 Yeah i'm basically out of luck..the united health care wont help me...sooo i'm considered self pay...the surgery is 11,800 but i'm going in a few weeks to be put to sleep and check for any hernias if i have one (which i actually hope i do) my price will be knocked down to 6,000...keeping my fingers crossed What do you have to come up with upfront? Why wont United cover it for you? Im scared they will deny me too! 1 melissa1104 reacted to this Share this post Link to post Share on other sites
melissa1104 5 Posted September 6, 2013 thank you beauty!! and to mommie4- i had a weight loss surgery exclusion on my insurance. Share this post Link to post Share on other sites
Mommie4 53 Posted September 6, 2013 thank you beauty!! and to mommie4- i had a weight loss surgery exclusion on my insurance. oh ok...that sucks! Share this post Link to post Share on other sites
RJOnTheWay48 0 Posted September 8, 2013 I have United Health Care through my husband's company, I called and talked to a representative who told me they covered the sleeve. Now they say no we will cover bypass but not the sleeve and the doc's office called me to tell me that if my husband could go to his human resources person maybe I could get that approved. Yes go talk to a man who does NO work whatsoever, never returns calls and never does much work unless he might lose his job otherwise. Then they told me if my doctor writes a letter stating I've been on a weight loss program with her for over 6 months and that goes to insurance plus my husband goes to his HR person then we'll have that one taken care of too. All dedictibles are paid up for this year because my daughter had a baby in February so that took care of most family ded. and mine are paid because of my bad health. But if I have to wait 6 months that starts over new deductibles and will cost more, all must be paid upfront. I was really upbeat when my neurosurgeon discussed this surgery with me, now all of this is getting me down. Any suggestions ???? Share this post Link to post Share on other sites
Mommie4 53 Posted September 9, 2013 hey! I'm thinking of making the leap and getting the sleeve. was originally going to get the band but after really reading about both decided the sleeve is the better option for me. i have united health care do you think they will cover my surgery? i do have a BMI over 40 It depends on the coverage that ur employer has. You should call United and just ask them. I have united through my husbands work and its covered. BMI of 40+ is covered with no comorbidities, BMI below 40 you have to have like two comorbidities. They require me to have a 5 yr obese weight history (BMI of 35+ for past 5yrs). They don't require a pre-op diet because of the weight history. Just call and find out from them what they require and if ur covered. every plan is different and every ones answers on here will be different...lol GOOD LUCK Share this post Link to post Share on other sites
ribearty 544 Posted September 25, 2013 My doctor's office and I have received verbal approval from ins. co. for my surgery. In order to get a surgery date, my doctor's office requires the written letter. The letter was mailed on 9/18. Hope it arrives on 9/25. I am a band to sleeve revision patient. Optum waived the six month supervised diet criteria due to band complications. Looking at a 10/8 if available by the time I get written approval. If that date is unavailable I will have to wait until 10/25 due to work obligations. Very excited but still a little nervous even though I know it is the right decision for me. Share this post Link to post Share on other sites