Reasons for Rejection?

[gina171 626]

I am new, and wondering what are the reasons insurance would deny approval for WLS?

My BMI is 48, sadly. And I suspect I have sleep apnea. But isn't the BMI alone a clear reason to approve?

Anything I need to be careful to do or NOT do, in order to not ruin my chances for approval? I have United Healthcare, and have confirmed sleeve surgery is a covered benefit if BMI is over 40.

Thanks for any advice!

Sent from my iPad using the BariatricPal App

[2goldengirl 2,076]

Get a copy of your health plan's criteria for WLS and put your mind at ease. Also find out what your out-of-pocket will be and whether there is a cap on benefits for WLS. Then you will know for good and for certain.

[kmorri 1,689]

Exactly what @@2goldengirl said! Each insurance plan has their own set of requirements.....make sure you know what the requirements are with your individual plan. Call them first thing in the morning and ask that they send you a copy of the medical policy that pertains to weight loss surgery. Knowledge is power!!!

[haleymarie 35]

United healthcare makes it a breeze to get approved in my experience! Trust your surgeons office & you'll be here in no time! I had my first appointment in the middle of February and im getting sleeved tomorrow morning (:

[SalOdyssey 441]

Too many variables to answer this. But as @@2goldengirl said above get the criteria from your insurance plan.

Dr's will run whatever pre-surgical tests they feel they need, sleep study, stress test, lab work, X-rays, etc, to make sure you're a safe candidate for surgery.

Best of luck to you @@gina171!