united health care

[shirley36 14]

hi in new i have my first dr.app.next wk.and i have united health care i wanted to know if anyone eles has them also and what all will i have to go throw to get approved

[Allison0927 329]

i have it - the plans vary but BASICALLY unless the employer opted not to have bariatric surgery covered - you need a 35+ BMI with at least 1 co-morbid condition or a 40+ BMI on record for last 5 years (no need for a co-morbid condition). On record means with your dr's office. They let the 5 years slide sometimes especially for otherwise healthy people that may not have weighed in at a dr.'s office every year for past 5 years - ALSO and this varies by plan - you may be required to go through a 6 month dr. supervised diet first - i did not but again it varies by plan. BEST OF LUCK TO YOU!!!!!

one warning - i do not know if this is true AT ALL but i saw or heard a rumor that UH is doing away with bariatric surgery coverage beginning in 2012. I tend not to believe this rumor -but if i were you i'd get going on everything quickly just in case.

[2bfit 62]

Hi there! I have UHC Signature Value *** (live in CA). It used to be Pacificare ***. It has been a journey to say the least. Back in July I was dieting so when my PCP submitted the request for a consult my BMI was at 39. I was denied stating that it was not medically necessary which I appealed. It got denied again because I did not have their covered list of comorbs. So I have 2 letters, one from my medical group and one from UHC stating according to MY health plan to be approved for bariatric surgery you have to have a BMI of 40> or 35-39 with certain comorbs. In Sept I went back to see my PCP and my BMI was at 41.6. The consult got denied stating that although I met the requirements of having a BMI of 40> I needed to show a motivated attempt to lose weight for 6 months. My PCP sent in the records from the 2 year medically supervised diet I had done somewhere else with my gym membership information. I was finally approved for the consult. Now the surgeon met with me and states it's medically necessary and that my BMI is 41 and I am morbidly obese. The medical group came back and denied the surgery citing another plan's evidence of coverage within UHC. It's a Medicare plan! It does not even match my evidence of coverage or the 2 letters I have from them. They also wanted me to have 3 additional visits with the NUT. It will end up being a total of 4. I have already done 2 of them. They also wanted me to enroll in their medical weight mgmt program that puts you on Medifast. The NUT is against it and is documenting her chart notes to back me up on not doing Medifast. I have already tried Medifast in the past and it didn't work! I am so irritated with them! I appealed and I sent in copies of the 2 letters that indicated what they said MY health plan covers along with the proof of the medically supervised weight program and gym membership.

I must be getting close to approval if they feel they have to play games! I have called the new appeal case manager. She is getting tired of me I think. :huh:I submitted the 21 page appeal on 10-14. I wanted to blind them with paperwork so that they know I will take this as far as I can. The next level is an IMR through the state commissioner. I knew it was going to be tough to get approved because I have an H M O and they can be notorious about these things. But this is ridiculous.

I am sitting and waiting and I feel like I am going crazy. It's all I can think about which isn't healthy!

[soccermonster31 8]

I didn't have any issues with UHC. I'm using it as secondary insurance under my husband. My insurance excluded bariatric surgery but his did not. I was originally told I would have to do the 6 months of monitored weight loss, but 2 months in they came back and said I didn't and could have surgery right away. I just had to have a medical recommendation from a primary care physician. I was approved 6 hours after they submitted the approval paperwork. I didn't have any medical issues, just a BMI over 40. Our plan is covering the surgery 100%. I know this probably isn't typical, but I feel extremely lucky how easy the process has been.

[shirley36 14]

[quote name='soccermonster31' timestamp='my bmi is 46 and i dont have any health problems i wonder if i will get approved

[Lytha 2]

I just joined Untied on Sept 1. I found out I was approved for surgery on last week (on Oct 15) The major delay was getting my cards. I had already jumped through hoops for Tricare and got approval from them.

[soccermonster31 8]

[quote name='soccermonster31' timestamp='my bmi is 46 and i dont have any health problems i wonder if i will get approved

Your surgeon's office might be able to give you a good time frame as well. My insurance girls were amazing and knew exactly what I needed and when and then who to call to push the approval through.

[shirley36 14]

ame='shirley36' timestamp='1319139697' post='1676273']

Your surgeon's office might be able to give you a good time frame as well. My insurance girls were amazing and knew exactly what I needed and when and then who to call to push the approval through.

everyone thank you , u all helped