United Health Care and Doctor's recommendation

[TCL28 0]

Hi everyone -

I am seriously considering the lap band but when I talked to my doctor about it he said he did not recommend it for me. I am 248 and 5'11. I have gain 10lbs a year for the last 4 years. I have no energy. I just had a physical and my doctor said I was very health except that I need to lose weight. I have tried for 4 years to lose weight and I can't so I don't think his 1200 calorie diet is the answer. I tried it and lost 4 lbs - back up to 248 now though.

I have talked to a couple of plastic surgeons and they said I have to be 250lbs and have a bmi over a certain number and have another health related problem like sleep disorter or something. I hear of alot of people going to Mexico to get it but I wont be able to do that for months and I am anxious to get started. I live in Auburn Hills, MI does anybody know a good reputable doctor up here? Also, anyone have any luck getting United Health Care to pay for it? Thank you all for the great posts - you have really given me the courage to want to do this.

[LEWAN 0]

I Have United Health Care And They Have A Rider In Our Policy That Says No Bariatric Surgury Is Covered

[stef123633 1]

Most policies have different coverages, regardless if they are the same carrier, it really depends on the plan your employer picks. You'd need to call to see if they cover it and what the requirements would be. You don't quite have a BMI of 35 which most require (with co-morbidities) so it probably won't be covered regardless.

Good luck

[Jodi_620 37]

I have United Healthcare and they are covering my surgery. I have a BMI of 41, I had absolutely no problem getting covered they didn't require anything from me. But from the information you provided, it is possible that you will not be able to get insurance to cover it. Most policies have guidelines of a BMI of 35 to 40 with comorbities OR a BMI over 40. Your current BMI is 34.6. Being just under 35 with no health problems there is a good chance that they will not cover it.

With the guidelines I mentioned at your height you would either need to be 251lbs-285lbs with comorbities or 286 plus pounds with no health problems.

Edited May 27, 2008 by Jodi_620

[TCL28 0]

How are you doing on the pre-op liquid diet. I thought about trying that to see if I could lose weight but I can't even make it 3 days. How are you able to get through this?

[Jodi_620 37]

Surprisingly well. The first four days were the hardest. I gave up my beloved Diet Pepsi on the first day of my diet so that made things a bit more difficult. I dealt with headaches from the caffeine withdrawl for the first two days. The fourth day was the worst- I felt awful and almost gave up, I was hungry, dizzy, irritable and I wanted carbohydrates so bad. But I toughed it out and by day five things were much easier-not easy but easiER. I just take it one day at a time and any time I feel hungry I take in some Protein. I have lost 13 pounds.:smile2:

[juliegeraci 7]

I have UHC and I believe my plan had me to be BMI of 40 with no comorbesities. They approved the surgery without a 6 month diet as well.

[vkcse03 0]

Hi TCL! I live in Rochester, MI and have my first dr consultation tomorrow. I also have United Health Care but they want you to jump through too many hoops (as stated above) in order for the surgery to be covered. I finally deceided to pay for the procedure myself. I found a place out of Harper Hospital downtown Detroit. Their price is very resonable and their criteria is set lower than the Ins companies. According to their web page they will consider wls starting w/ a BMI of 30 if you are 'self-pay'. My BMI is 34. Let me know if you want the name of the dr and place. I'll be happy to share what info I have with you (I should get pay for all the referrals that I'm giving:tt2:)

[redheath 0]

Hi TCL-

I also have UHC and went through the process, my BMI is 35 w/2 comorbidities. They would not approve mine w/o a sleep study that will cost more than the surgery. My experience with UHC is that they always try to find a way to deny, deny, deny. I've had problems with them covering Chiro & prescriptions. I'll probably end up doing the sleep study since I so desperately need this surgery. I could have self paid with all the diets and personal trainers I've spent to try to get healthy.

[vkcse03 0]

redheath: I know exactly what you are talking about. By the time I go through the 6 mth dr supervised diet, I could have paid out of pocket for the band surgery already. I tally the costs and decided to pay for the surgery myself. I just had my dr consult yesterday and was approved for the surgery. When I told the dr that I am paying for the procedure all he was looking at was my BMI and health issues. He did not even ask me about my dieting history! It's so easy when you're self-pay.