First Post...and Very Frustrated With Uhc

[abuckeyeleaf 16]

Hey yall, I've been lurking for a while (and even have the iphone app) and finally decided to join up and make myself known. So hi, I'm Lea.

My application packet was submitted to UHC about 2 weeks ago and I'm already sensing trouble. I got a call from Optimum Health today, apparently they are contracted by UHC to handle all things bariatric, at least for my plan (choice plus). I returned the call and they didn't seem very organized, they asked if I was calling for benefit information...no, I'm returning your call. They proceeded to ask me all of the questions I had answered and were part of my application packet. We also discussed the requirements, which were COMPLETELY different from what UHC told me when I called initially - first, no supervised diet was required but a psych eval was, but now no psych eval required but a supervised diet IS. And guess which I don't have. The kicker - a nurse will review the information provided and call me in a MONTH. head, meet desk.

I guess I'm hoping for a miracle at this point and that they'll let me slide. Unlikely, I know. But a girl can hope. I submitted a partial food diary from the daily plate, but the 8 months I tracked food/exercise/weight/BMI has mysteriously disappeared since the daily plate and livestrong merged. I also didn't save my weight watcher documents from when I participated in college.

My PCP won't do a supervised diet for me because she knows what it's for, she also refused to write a letter of medical necessity because she has a personal bias against WLS. She told me the only supervised diet she would do for this would be to make me eat the post-surgery diet and portions for six months which I'm not sure I could live like that with a normal sized stomach.

Sorry to vent in my very first post! I'm just already feeling the looming frustration and discouragement. I first saw my surgeon in late 2011, but do do job changes, subsequent layoffs and no insurance for a while, had to postpone everything. I've had a lot of negative things happen recently and am just ready for some positive.

Pessimism aside, glad to meet you all!

Lea

[434teresa 20]

Sorry to hear that your Dr is being that way. I am doing my 6 months now. Have you been to a seminar with the bariatric dr that you will be useing? If not you want to.. That is how I found out what my insurance requires to have weigh loss surgery. Everytime I called my insurance they did not know much about the requirements at all...I have to do a 6 month diet like you do but I also have to have 2 dr. visits for each of the past 5 years(so require 3 years) showing that I was over weight, then a letter from my family dr saying that I am cleared for the surgery. They said in my seminar that those things was pretty much the same with all the insurances around here. I have other things to do like a nutritional assessment and a psychological assessment which they also require(those things have to be within 6 months before the surgery).

Can you change Dr.s? If I could that is what I would do. Your new Dr. could always get all of your records from your old Dr.

I dont see how your Dr would even think that you would be able to eat the way someone that has had the surgery done already can for 6 months. I mean the surgery gives you a smaller stomach to fill and helps ad in you eating the smaller amounts of food that you are to eat then.

[abuckeyeleaf 16]

I didn't do a seminar I just went directly to the surgeon. I've had my bloodwork done, psych eval, and my obgyn wrote a letter of medical necessity.

I'm just discouraged about having to postpone for another six months, I have knee injuries and I hurt. I've tried everything and I'm frustrated with the possibility of having to go through six months of formalities.

[Sojourner 2,446]

Hey yall, I've been lurking for a while (and even have the iphone app) and finally decided to join up and make myself known. So hi, I'm Lea.

My application packet was submitted to UHC about 2 weeks ago and I'm already sensing trouble. I got a call from Optimum Health today, apparently they are contracted by UHC to handle all things bariatric, at least for my plan (choice plus). I returned the call and they didn't seem very organized, they asked if I was calling for benefit information...no, I'm returning your call. They proceeded to ask me all of the questions I had answered and were part of my application packet. We also discussed the requirements, which were COMPLETELY different from what UHC told me when I called initially - first, no supervised diet was required but a psych eval was, but now no psych eval required but a supervised diet IS. And guess which I don't have. The kicker - a nurse will review the information provided and call me in a MONTH. head, meet desk.

I guess I'm hoping for a miracle at this point and that they'll let me slide. Unlikely, I know. But a girl can hope. I submitted a partial food diary from the daily plate, but the 8 months I tracked food/exercise/weight/BMI has mysteriously disappeared since the daily plate and livestrong merged. I also didn't save my weight watcher documents from when I participated in college.

My PCP won't do a supervised diet for me because she knows what it's for, she also refused to write a letter of medical necessity because she has a personal bias against WLS. She told me the only supervised diet she would do for this would be to make me eat the post-surgery diet and portions for six months which I'm not sure I could live like that with a normal sized stomach.

Sorry to vent in my very first post! I'm just already feeling the looming frustration and discouragement. I first saw my surgeon in late 2011, but do do job changes, subsequent layoffs and no insurance for a while, had to postpone everything. I've had a lot of negative things happen recently and am just ready for some positive.

Pessimism aside, glad to meet you all!

Lea

This journey, and the hoops many are required to jump through, requires patience and perseverance.

My band surgery was delayed for well over a year after I had completed my PCP supervised diet...he was kind and understanding enough to "keep the approval window open" for me to work my way through numerous unanticipated medical issues my husband and I had to cope with. The delay only served to make me more determined to do this and get really healthy again.

Don't give up...and just stay on top of the requirements and understand exactly what the insurance company needs for your approval. This is not mission impossible...good luck!

[lassie 247]

do not give up it took me a full year jumping thru all the hoops. Maybe you should find a doctor at the hospital that you will have it done and bypass your doctor. The hospital staff is very good at working thru all the concerns as they want your bussiness Good luck to you and hugs.

[abuckeyeleaf 16]

Thanks for the encouragement everyone. I did see on the Optimum Health website that they accept weight watchers as a supervised plan. Although I didn't retain my WW documentation from college, my work has a discounted program starting next week....15 weeks for under $7 per week. While I hope that the documentation i provided will suffice for UHC, if not, at least I'm on the way.