Mrs.G8181

UnitedHealth care insurance

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hello, I am new to this journey. I contacted my insurance company about gastric sleeve surgery, they don't cover it, but  you have to meet a criteria.  Well I don't have any major medical issues other than PCOS, and pre diabetic. Has anyone been able to get approved with not having serious medical conditions?

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United did not cover it for me, but Tricare did. I was reasonably healthy, but there were a lot of stats going downhill.  Get tested for sleep apnea. United covered the test and most of the equipment cost for me. Arthritis, prediabetes, PCOS, high blood pressure and high cholesterol are also supporting causes.

Our clinic has a patient advocate. She is an expert in getting the surgery approved. Maybe your clinic has one, too?

This is life-changing. I will be thinking of you.

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I honestly don't know what to do because this is the only insurance I have.

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United covered the procedure for me - they did not require any co-morbidities. I had no requirements for any nutrition counselling, physician supervised weight loss, or psychological evaluations. Their only requirements for me were a BMI within a certain threshold - and the procedure must be in an in network facility by an in network surgeon. They were very easy to deal with, and my approval was surprisingly fast - only 14 days from the time my surgeon submitted. I have their Choice Plus PPO through my employer.

Edited by jenn3366

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i have checked on my policy and weight loss isn't covered at all. Ugh there are criteria s to meet .  if your BMI is. 35 or below. But none if it's 40 and up.

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I am so glad they covered it for you, Jenn. :-)

It seems each employer can request a different package of benefits. My company is tiny, so they couldn't afford more. Fortunately, I had a backup plan.

Mrs G, I have read you can ask your employer to upgrade this on a case-by-case basis, so it may be worth checking out. In the meantime, pursue more intensive testing and ask the surgery clinic for help. They have a strong incentive to get you approved.

Don't give up!

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Ok thank you I meet with the Doctor in April.to go over stuff. I sure hope he has tricks lol. No but seriously thank you for Your comments. My insurance is through my husband. When u called UHC she looked at the most expensive plan and it still didn't cover it.

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Do I need to go to my primary Doctor before I meet the Weight loss Dr? To get my bmi ?

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17 minutes ago, Mrs.G8181 said:

Do I need to go to my primary Doctor before I meet the Weight loss Dr? To get my bmi ?

You can do it yourself online. Just google BMI calculator. I just used one using the stats you provided and it is currently 35.5. Be careful to not let it fall below 35 before you see the surgeon.

Edited by Aussie H

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