B/C B/S PPO vs United Health Care??

[Mrsace13 0]

I went to the seminar last night and they were so helpful regarding different insurances. I have B/C B/S PPO now and they said approvals are pretty easy with them except they require the 6 months and of course I'm ready to jump on the operation table tomorrow, lol.

We are at the end of the year where I can change my insurance from my dh's to mine, we have United Health Care, I was told from someone here that I should ask others on United since I guess some had problems. My problem is they said with United you have to have a 40 BMI and I rock back and fourth from 37-38 with medical conditions. United does not have the 6 months.

Then of course I would have to wait until Jan to start everything so I guess the wait game is the same at the end.

So for you that have B/C B/S PPO and for those of you that have United Health Care, I just wanted to know what you thought of your insurance, issues, problems.

I'm excited to get started, after the seminar I know the band is something I HAVE to do.

Thank you!!

[Jodi_620 37]

I guess it all depends, I have UHC with a BMI just over 40/no co-morbities and I was approved within a week with no hoops to jump through. I actually switched from BCBS because my policy wouldn't cover the surgery...

[kdlee 0]

Not all BCBS PPOs require the 6 month supervised diet. I have BCBS PPO and did not have to do the 6 month diet. You need to call the customer service number on your card and ask for them to send you in writing a copy of their policy on weight loss surgery, specifically gastric banding. That way, you'll know for sure. Each insurance policy is different, despite being the same insurance company. The coverage and specifics depend on what your employer bought into. Good luck!:crying:

[carolinagirl3 0]

I have UHC and it was very hard to get approved. In my case my bmi was 38 and I had ony borderline co morbities. My Dr even spoke to the medical director at UHC for our plan and they turned him down! Our company is self insured and only pay UHC to administer the plan so my husband pulled some strings and got the company to tell UHC to cover the surgery. We were very lucky that he was in a high enough position to get them to do it otherwise I would not have met the critera for the surgery. We were prepaired to self-pay in necessary. I wish I had better news for you but this is what we had to deal with.

[Bimbabe 1]

I have BCBS PPO. According to my policy, they will cover a BMI of 35+ with comorbids. Here is exactly what my BCBS PPO listed as criteria:

BMI of 40 or BMI of 35 with at least one significant co-morbidity (e.g. high blood pressure, diabetes, etc.) AND

Documented failure of weight loss attempts AND

Obesity present for at least 5 years AND

No untreated metobolic/endocrine abnormailities AND

Adult (achieved full growth)

I met all of the above criteria and was approved in 48 hours!:crying:

[Mrsace13 0]

I have BCBS PPO. According to my policy, they will cover a BMI of 35+ with comorbids. Here is exactly what my BCBS PPO listed as criteria:

BMI of 40 or BMI of 35 with at least one significant co-morbidity (e.g. high blood pressure, diabetes, etc.) AND

Documented failure of weight loss attempts AND

Obesity present for at least 5 years AND

No untreated metobolic/endocrine abnormailities AND

Adult (achieved full growth)

I met all of the above criteria and was approved in 48 hours!:biggrin:

Did you have to do the 6 months? I was told by the dr office that I have to go weigh in once a month for 6 months and go to all these different appointments. I'm OK with the test, I would love to have all these test on me but I hate waiting 6 months. I will have co pays at each dr's as well and I know that will start to cost a lot. But if that is what I have to do, then of course I will.

Thanks everyone!!

[*slim* 2]

Did you have to do the 6 months? I was told by the dr office that I have to go weigh in once a month for 6 months and go to all these different appointments. I'm OK with the test, I would love to have all these test on me but I hate waiting 6 months. I will have co pays at each dr's as well and I know that will start to cost a lot. But if that is what I have to do, then of course I will.

Thanks everyone!!

I have BCBS PPO and I had to have a 6 month diet done within the last 2 years. That part depends on your employer also. Another thing is, some surgeon's office actually require it whether your insurance company does or not. I would either call or email my provider (that's what I did) and get something in writing concerning what they cover and under what circumstances. Once you have it in writing, you won't have to guess or be disappointed later to find that you missed something. Good luck to you.

[Bimbabe 1]

Slim in TN-

You must be sooo excited! Only 3 more days!!! WHOO HOO!