Clinical Policy on WLS for UHC?

[MacMadame 81]

A while back someone posted the official clinical policy on bariatric surgery for Aetna. It looks like I won't be able to get this surgery with Aetna because my employer excludes it and I will have to switch to one of our United Heathcare policies.

So I'd like to find the official policy for UHC. I haven't been able to find it on their web site though.

I'm interested in what their policy is for approval and also what their requirements are. I meet the NIH guidelines... BMI over 40 plus 1 co-morbidity. But when I called our UHC hotline, they said they only approve if you are doing it to treat another disease and it wasn't clear if hypertension was one of the ones they allowed.

It's hard to get info out of them since I'm not a member yet (plus every time you call these companies, you get a different answer).

If I'm not getting approved with either one, I want to stick with Aetna as the policy I have with them suits my needs very well and the UHC policies we have are what are called "affinity" plans and I don't think will work as well for our family. But if switching means getting insurance to pay for it, then I'll switch.

[Mom2_4 0]

I don't know what the official policy is. When I called UHC about WLS originally, I was told that I had to have a BMI greater than 40, and to have had a diagnosis of morbid obesity for at least 5 years. That was it, no 6 month plan, nothing about comorbidites, etc. I don't know if this was policy specific or their policy in general since my husband works for a company that is really big on health and wellness. We had a different UHC policy a few years back when my husband worked for a different company that had an exclusion for WLS and they said at that time, NOPE, NO WAY, NOOOO! So who knows.

Hope you find your answers soon!

[MacMadame 81]

I'm really curious because UHC seems to have a bunch of different policies rather than one policy. Because everyone on here seems to be told a different answer. I was told it would only be approved if I had a co-morbidity and WLS was considered a "cure" for it when I called on the phone. But I'm finding you can call insurance companies five different days and get five different answers so I really want something in *writing*!

I'm going to have them send me a copy of the policy (not the plan summary) and see if I can get them to fax me their requirements. I'd feel better if I knew ahead of times what they were though. It makes it easier to judge if you are getting wrong info.