Ensuring qualification

[trish in texas 0]

Keep being told, "you have benefits" by the dr's office, BMI 36, no high bp, cholesterol, no apnea, no real problems. Have had all the test accept stress test, told I need to have one problem! Doesn't 20 years of being overweight count, have UHC-choice plus.

[faithmd 14]

It does not usually count. You must have a co-morbidity. You *can* be healthy and still be fat.

Not saying I would ever want to, though.

Does not matter one little iota what the MD office tells you, not a whit. You MUST call your insurance company and talk with someone in the complex case management department, or whatever department handles bariatric surgery claims. You need to ask what their qualifications and requirements are for Adjustable Gastric Banding. Then have them mail it to you so you have it in a hard copy.

Asking questions here is a great idea, but I could also have OHC-choice plus and my employer might have an exclusion for my policy against WLS, and you might be okay. That's why it really is so important to call your insurance company and ask.

My surgeon will word things so that having a strong family history of things like diabetes or heart disease, etc. will be a comorbidity.

Good Luck!

[trish in texas 0]

Thanks, have my hopes up, and worried it could be too good to be true.

[faithmd 14]

Here's a link to a thread all about UHC Choice Plus. Just a reminder, everyone's plans are not the same. One may have coverage for surgery, another may not, but I hope this helps:

http://www.lapbandtalk.com/showthread.php?t=28025