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whispers_37412 | Will United Healthcare pay for my gastric bypass surgery? |
My doctors have deemed it medically needed and my BMI is a 50.18. |
 |
 
SuzeY
 |
Call UHC and get it approved before doing anything. They're not known for being great payers (ask any doctor's office), so make sure you not only clear the surgery, but the surgeon, the anesthesiologist and anyone else who will be touching you during the procedure. Just because the hospital may be covered by UHC doesn't mean anything else will be. You'd hate to find that out the hard way! |
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Suzanne: YPA
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This depends upon whether or not gastric bypass surgery is listed as a covered benefit in your policy or certificate of insurance. Check the "covered services" section. If you don't see it listed, check the "exclusions" section to see what that says.
As others have suggested, you can have your doctor's office attempt to get the surgery preauthorized. If the surgery is not listed as a covered benefit, then the preauthorization request will be denied, regardless of medical necessity. |
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zippythejessi
|
Probably not, but you need to call them and specifically ask about your plan. There's hundreds of variations to United Healthcare, all dependent upon states' regulations and individual employers - they pick what riders to allow on the plans.
If it's not a covered benefit, your doctor can provide proof of medical necessity and ask them to pay for it. It's no guarantee, and if they still say no, you can't force them to pay for it because it's generally an elective procedure, and 99.9% of plans will not pay for what they deem to be any elective or cosmetic procedures. |
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David W
|
Suzanne's answer is correct. Insurance companies issue health insurance with many different benefit designs. It is possible that a company would cover it for one individual and not another because their policies are slightly different.
Don't call. The doctor's office should prepare a plan of treatment and submit it for review before the treatment begins. The insurer will respond with their pre-determination. If you like it, go ahead, if not, you may be able to appeal it.
What the doctor says is medically necessary doesn't necessarily match what your coverage says. And find out the maximum it will pay, and your expected out-of-pocket (including hospital and follow-up costs). |
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Leo
 |
Weight loss surgery-like gastric bypass /lap band surgery / stomach stapling and gastrectomy have become very common and very safe now. My cousin got her Roux-en-Y gastric bypass surgery in India. She has lost more than 65 lbs in 5 months and is very happy with the results. The price for obesity surgery is very less in India. My cousin just paid 25% of the cost she was quoted in America. She got her surgery from a company called Forerunners Healthcare.
Forerunners Healthcare is very famous in India. I read a lot about them in the Newspapers and magazines. I have read a lot of their patient stories also. They arrange financing for USA, Canadian, UK and other international patients who plan to have surgery abroad for low cost, as bariatric surgery and weight loss surgery is not covered by insurance. They also have photos pasted of their International patients. You can checkout their website. There are huge cost savings. As a doctor I personally believe that your Obesity surgery can be easily handled in India, as the quality of healthcare available In India is simply best in the world. The surgeons are USA/UK trained and facilities are 5 star.
http://www.forerunnershealthcare.com
Hope this helps. |
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ny2fl
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i strongly beleive they will, especially due to the medical necessity of the procedure. i know someone who had this while on united healthcare. good luck |
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Lin B
 |
i think you should just try calling your healthcare provider and asking them directly. |
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SCORNEDLUVHER
|
IT DEPENDS ON WHAT TYPE OF UHC PLAN YOU HAVE.
USUALLY WITH MOST TYPES OF PLANS, YOU WILL NEED PREAUTHORIZATION FROM YOUR INSURANCE COMPANY FOR BARIATRIC SURGERY. I WOULD HAVE THE SURGEONS OFFICE CONTACT UNITED HEALTHCARE TO VERIFY BENEFITS TO SEE IF BARIATRIC SURGERY IS COVERED UNDER YOUR PLAN. YOU MAY ALSO WANT TO CONTACT THEM YOURSELF JUST TO BE ON THE SAFE SIDE. BECAUSE OF YOUR DIAGNOSIS, YOUR INSURANCE COMPANY MAY DEEM YOUR SURGERY AS A "MEDICAL NECESSITY" |
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