Does United Healthcare Cover Bariatric & Metabolic Surgery in Florida?
Insurance coverage and cost are often the first thing on a patients mind when they pursue weight loss surgery. Planning for bariatric surgery can feel overwhelming, but our team is experienced and prepared to help you navigate the process to a successful surgery with our team of board-certified bariatric surgeons in Jacksonville, Florida. United Healthcare, one of the leading insurance providers in Florida offers a wide range of different plans. This may be through employer coverage or with a private pay plan. Your plan may be individual, family, or Medicare, and you may have coverage for weight loss surgery! MASJax is in-network for most UHC insurance plans. This means lower out of pocket expense than with providers that United Healthcare labels out of network. Coverage for weight loss surgery typically requires that a patient meet specific insurance guidelines and that medical documentation be submitted. Working with an experienced bariatric program, like that at MASJax, can help you progress smoothly and confidently through the process to having weight loss surgery with coverage through your UHC plan.
Will My United Healthcare Insurance Policy Pay for Weight Loss Surgery?
Typically, when a policy does NOT have coverage for a specific procedure, it will clearly spell it out as a policy exclusion. We recommend you check for this, both by reading your policy documentation and contacting your United Healthcare customer service for assistance. We urge all patients pursuing weight loss surgery to take the time to contact United Healthcare directly for confirmation on bariatric coverage. Our team works to verify benefits for each patient, and we ask to you do the same. A contact phone number should be printed on the reverse side of your insurance card. This is the best way to reach a representative at UHC to discuss your policy and coverage.
If you are covered through your employer, you may also opt to discuss this with your Human Resources department’s benefits manager. Exclusions for weight loss surgery are not the norm, but they do occur in some policies. It is helpful to verify your weight loss surgery coverage early in the process to save yourself unexpected expenses or surprises later.
For bariatric procedures, UHC policies generally contain a specific section laying out the details of what procedures are covered, and which are not. This section should also clearly state guidelines for coverage, or the criteria a patient should meet to be considered for coverage. We use these guidelines to help ensure a prior authorization with UHC. While prior authorization is not a guarantee of coverage from your insurance company, it is a positive indicator that guidelines have been satisfied.
Your policy is unique and can differ from other plans and groups…even year to year. We urge weight loss surgery candidates to rely only on information stated in your policy. We invite all individuals interested in bariatric treatment to contact both our office and United Healthcare directly to help best understand coverage for weight loss surgery.
What Will I Need to Pay for Weight Loss Surgery?
What you will pay can look different from one patient to the next. Factors like policy structure and other healthcare expenditures can impact the actual amount a patient is responsible for paying. Copays, coinsurance, individual and family deductibles, and/or an out of pocket max need to be considered when planning for surgery. Also note, the remaining balance of each may shift as you pay medical expenses over the calendar year. You may have other expenses during the year that make the actual out of pocket lower should you complete the process before the end of the year.
Your eligibility for coverage for a particular weight loss treatment does not usually mean 100% coverage but for those meeting their out-of-pocket maximum for the year, this may be the case. Our bariatric team will take time to meet with you and review your benefits and estimated financial responsibilities with your United Healthcare coverage.
Do I Qualify for Insurance Coverage of Weight Loss Surgery?
What is required by your policy for bariatric surgery coverage may vary slightly. Generally, the following criteria are common for pre-approval. You can verify your specific criteria by referencing your policy:
- BMI 40 or greater, or 35 or greater with a related medical condition
- Obesity diagnosis on record
- Formal documentation of past weight loss efforts which may require a physician supervised weight loss program
- Smoking cessation at least eight weeks before surgery
What Bariatric Procedures Will United Healthcare Florida Cover?
The core bariatric procedures are typically covered by UHC policies. These include the sleeve gastrectomy, the Roux-en-Y gastric bypass, and duodenal switch. MASJax’s team of bariatric surgeons regularly perform these surgeries and we have seen patients enjoy wonderful success with each. Lap-Band may also be covered under some policies; however, we typically don’t perform this procedure. United Healthcare will not cover specific procedures they deem to be experimental including the mini-gastric bypass, intragastric balloon, and lower BMI cases.
If you previously had a bariatric procedure but have either not met your goals or have had uncontrolled weight regain, a revision bariatric surgery may be warranted. The guideline for coverage of a secondary weight loss surgery may be stricter and often a patient’s medical record must indicate the cause of failure is not a lifestyle consideration. For past bariatric patients looking to revise their procedure, please contact our office for more details and next steps.
My United Healthcare Plan Excludes Bariatric Surgery… What Are My Options?
Although research indicates bariatric surgery is successful, some policies simply do not cover it as treatment for obesity. We have carefully created a comprehensive self-pay program to accommodate patients who do not have bariatric insurance coverage. We also work with third party financing options to assist patients without coverage or with very high out of pocket expenses. Self-pay is also a great option for those who wish to avoid stringent insurance policy criteria while still having the best in bariatric care.
How Do I Contact United Healthcare?
United Healthcare can be contacted by telephone or through their website. Reference the phone number on the back of your insurance card to reach the correct department and avoid misinformation. For more information about UHC: https://www.uhc.com/