UHC

[revision in TX 38]

I also had UHC, with a "bariatric" exclusion.

I took money out of my IRA to self-pay for surgery; glad I did.

But...be VERY careful. My doctor billed "other" charges to insurance; they covered most of them( because they were coded as "medical" rather than "bariatric". That would be fine IF I got a refund, but he kept it ALL! Now, I'm having to fight with insurance and the doctor to keep him from being paid twice!! After charging me $22K for the surgery, th ey billed ANOTHER $30K to insurance...which makes my surgery (billed) amount around $55K!!! What a scam!

And...they get away with it, because you can't do an insurance appeal, because it was not denied. They code it as if you had all these add-on procedures ("discovered" at time of surgery--NOT!) so insurance will pay, but they will keep it ALL!!! Makes sure it's VERY CLEAR what (if any) is self-pay and/or what is insurance coverage; otherwise, they will bill both and make extra money off you. It is "the norm" in bariatric surgery practices nation-wide.

[nursesabby 7]

I have UHC with a custom wls plan. 35 bmi with 2 co-morbidities or 40 bin. Must have policy 2 yrs before wls covered. I have NUT training with UHC which takes about 2-4months, but my surgeon requires a little more so all in all process MAY take up to 6 months. I did not have to provide 5yrs of records or anything like that. I have an amazing case manager I work with that answers and helps me with all my crazy questions. All you can do is call. Like so many have said there are many different UHC plans

[jtickle 295]

UHC PPO

I am so confused about the plan requirements. Yes, gastric bypass is covered. BUT, you have to have 1) BMI 35 < with commodities, or 2) BMI +40. Now were my confusion comes in is about the 6 month diet. Has anyone gotten an approval without being required to do the diet? I'm concerned because i don't want to be put in this tug of war where i start the diet, loose weight and then the insurance (or surgeon) denies me because i no longer meet the requirements. I have been doing the yo-yo weight loss for years and it almost always comes back. Im tired of being so big.

My stats are, 5'3", 282 lbs, 49.9 BMI. I have always been big/heavy and it has gotten out of control. My mother died at 47 from diabetic complications and had HBP and heart disease. My father is diabetic, hypertensive & high cholesterol. I have been treated for weight loss with pills, thyroid (post pardum) and pre-diabetes with in the 12-18 months. My consult is 11/26/13. I am so anxious about what to expect.

My plan is effective January 1.

I have UHC. My plan does not require a 6 month diet or a psych evaluation. Like many other people have said in this thread, it depends on what your employer wants to require. I would call UHC and get your requirements in writing because everyone will tell you something different.