Insurance

marty123 · January 29, 2008

I have United Healthcare and they do not cover this procedure. Has anyone had United pay for their procedure? If you had to go thru the appeal process what had to be done? Any information someone can give me would be greatly appreciated.

arizonalisa1967 · January 29, 2008

I have united health care, and they are paying for my surgery, well my out of pocket is 4,000 , but the rest they are paying, it's a 29,000 surgery...

faithmd · January 29, 2008

Marty, please go check out the Insurance forum. As I recall there are quite a few folks there who have had UHC.

Also, just a word of caution, if YOUR policy does not cover Adjustable Gastric Banding because of an EXCLUSION, then you are sadly stuck.

Just because you and I may both have United, my employer may have paid for a Bariatric surgery rider, but yours may not have. That is why you may not have coverage, but I may.

Good LUCK! I hope this helps.

TRENYA07 · January 29, 2008

I have UHC and I was told that they do cover this procedure. I called myself to be certain (there is certain criteria that you have to meet, ie BMI > 35 without comorbidities).

kimmi5207 · January 29, 2008

As mentioned above, you need to find out if it is not covered because it is excluded from the plan, or if they denied you because they don't believe you meet the qualifications. If it is because you don't meet a qualification, if you have the backup, etc, an appeal is possible.

To save money, many companies exclude certain procedures from their health care plan. Especially smaller companies.

I had a friend that had an insurance company that is known to approve surgery if you follow a 6 mo supervised diet plan - but when she checked her insurance policy specifically, it excluded any WL surgery so she was not able to get it (could not afford to self pay).

So its not just the insurance company you have, its also the coverage that has been purchased by your company.

Call your insurance company and ask specifically if they cover bariatric surgery, or lap band surgery. If they do, ask what are the requirements. If they don't, ask why (i.e. if it is excluded).

FYI... I do have united healthcare and it was covered, but I work for a very large global company.

Good luck!