[Jason Gray]

I am a school teacher and I have united health care ppo insurance in Georgia. I currently have a BMI of 41 and have a stent in my heart, heart disease. high blood pressure, severe sleep apnea, low thyroid, and my blood sugar is now prediabetic. My health insurance specifically states that it does not cover wls but stories are circulating about people in my same school system with the same insurance having the surgery done and covered. Has anyone had a similar experience of having a United Health Care that specifically stated that it did not cover wls but got it approved on an individual basis because of comorbid conditions? Where do I start?

[mj2903]

Call them and ask to see the guidelines for surgical treatment of obesity. I had United and a Blue Cross policy and BC had the exclusion but under surgical treatment of obesity were the exceptions and conditions that they would cover it under. This was available on their website in an area for doctors but the rep told me how to get there and what to look for so I had the same thing as the doctors.

Good luck,

[T.Cobb]

I am having a similar issue with Anthem BC/BC not wanting to cover the WLS surgery, they say that my husbands company don't have that plan. I have a bad Thyroid, DDD (Degenerative Disk Disease), and pre diabetic. Also high Cholesterol. My BMI is up there too. Shoot they wouldn't even pay for the medicine Chantex for me quit smoking. Tell me how sad that is. IDK what to do, my doc has even submitted a letter saying I need this done and no such luck. Why pay all that money to them if ya can't use it when you need it?

T.Cobb

[torimagic]

I have UHC and even though the plan states that it doesn't allow obesity surgery when I called and asked they told me that it would. I just got my approval in the mail this week! I am waiting to have my preop testing scheduled and shooting for an October surgery date! Call and ask...you won't be any worse off than before AND if the answer is no, appeal! Good Luck!

[MotoCO]

How many clinics in your area that do the surgery? If there are only 1 or 2 then you might be able to call and tell them your situation and who you have for insurance and if they have ever worked around that insurance and they might be able to help.

Or it might be good to keep your ears open for someone in your district who has had the surgery and then approach them to see how they did it.

Good luck to you!

[sara5214]

Hi, I work for a school system in Ga. also. The system I work for allows you to pick if you want United Health or Cigna. I have been with Cigna HRA account a couple of years now and when it was time for my surgery they did GREAT about paying. But read your insurance book for this year, I know they didn't pay but I think they have started to pay for gastric by pass if your BMI is over 35 or 40 with other health problems. I also think that the hospital you use has to be a center of excellance. I used Emory in Atlanta and it was Wonderful from the Dr. ( S.Scott Davis) to even the finance dept.I think on of the hospitals in Albany Ga. is now a center of excellace but If I had to do it over again I would go right back to Emory. Three hour drive and all!! lol Good Luck and let us know how things are going!

[KarenCee]

Jason, I work as a teacher in Georgia have United Healthcare HRA. The HRA was the only tier that would pay for it but as of this coming January they will no longer pay for weight loss surgeries for Georgia State employees - including teachers. I have written the senator and representative in my area about this issue. I think this sucks big time. I am grateful that I had mine done before this was changed but I know a few teachers who wanted to have this done next summer and now they can't unless they pay out of pocket or finance it. I think this is a travesty to any state employee whose health would greatly improve with this surgery. But, from what I understand, they consider it an elective type procedure and with the cost of the surgery (and our pitiful state budget woes) this is probably why they have eliminated the coverage. I have to call next week to see if my remaining follow up visits will be covered since I had the surgery before they decided to drop the benefit.

I hate this...insurance companies playing doctor, at least that's what it seems like to me. Good luck to you Jason.