Consult your doctor
United Healthcare has no set policy for Lap-Band surgery; coverage varies by plan, and approval for surgery is granted on a case-by-case basis. To find out what is required of your plan, contact a benefits specialist with your plan and ask about Lap-Band requirements. In some cases, a letter of medical necessity from your doctor may be sufficient. Other plans may require more extensive documentation covering up to five years worth of medical history.
Letter of Medical Necessity
Most plans will require a letter of medical necessity from your doctor. This letter should state your weight and weight history, body mass index, any obesity-related health conditions and a description of any weight-loss programs you have tried in the past. Your doctor should explain why weight loss is medically necessary for you and how it will benefit your health.
Body Mass Index
United Healthcare plans typically require a diagnosis of morbid obesity, or a Body Mass Index (BMI) of 40 or higher. In some cases, an individual with a BMI of 35 or higher may be accepted for Lap-Band surgery if the patient has other serious health conditions related to the obesity, such as diabetes, sleep apnea or hypertension.
Weight History
Your United Healthcare plan may require up to five years' worth of weight history, so it is important to keep records from any doctors' appointments related to obesity. Be sure you understand your plan's exact requirements related to weight history, as any gaps in weight history or incomplete records may result in a denial.
Psychological Evaluation
Some United Healthcare plans may require patients to undergo a psychological evaluation. The purpose of a psychological evaluation is to demonstrate that the patient is capable of understanding the risks and requirements of the surgery and is also able to deal with the stress that may be caused by the procedure.
Supervised Diet
In some cases, you may be required to go on a supervised diet for a period of six months to show that you are unable to lose weight through other methods.
