Request submitted on 11/9 to UHC....

[FuriosMommy 3]

Hi everyone, I've been a lurker for too long! My approval request was submitted to UHC on Tuesday 11/9 I'm trying to think positive thoughts. I'm so afraid it'll be 3 weeks before I hear from them and then they'll just want me to jump through more hoops! I have UHC Choice Plus PPO, I was told that my only requirements are whatever the surgeon requires from me. Let's hope that's the case. I know it's all set up by the employer, so there's really no way of knowing by all of us comparing notes. Keep your fingers crossed for me please! I'm really hoping to have my VSG before the end of the year.

[Vicki 0]

Hi everyone, I've been a lurker for too long! My approval request was submitted to UHC on Tuesday 11/9 I'm trying to think positive thoughts. I'm so afraid it'll be 3 weeks before I hear from them and then they'll just want me to jump through more hoops! I have UHC Choice Plus PPO, I was told that my only requirements are whatever the surgeon requires from me. Let's hope that's the case. I know it's all set up by the employer, so there's really no way of knowing by all of us comparing notes. Keep your fingers crossed for me please! I'm really hoping to have my VSG before the end of the year.

Hay there I FEEL your pain. I have the same ins. as you do, believe me I could write a book. Prior to starting the "HOOP JUMP" I called MANY MANY times to make sure I was going about everything the way they wanted. Soooooo 7 months into it all I was denied. So they sent an appeal. The first time no person could tell me why. The second time I went for their throats for an answer. They said my ins. carrier had an exclusion in there policy that stated they would naver have covered it. I was in a conference that day, I went nuts on the phone, as nuts as i really get {not to bad}. I called my HR person at my husbands compay and ask for the HEAD honcho! Told him All that I had been thur twice that day I spoke with him, then the weekend came, monday he called and said no one could give him a real answer.........buy tuesday I was approved and today has been one week since surgery. Please do not let the system push you around just in case they try to. I REALLY had to fight for mine. Best wishes to. I hope you have a smoother time. Vicki

[FuriosMommy 3]

Thanks for the response Vicki. I'm glad you were finally able to get your surgery done and you're doing well. I was told by 3 people that I do for sure have 100% coverage and the only requirement was "whatever the surgeon requires" is what they would always say. So I'm hoping with my high BMI of 49 it'll go through easily. The only thing I was missing was one year of medical records. I sent them 5 years worth, but I had nothing for 2006. I sent them a letter explaining that I got married that year and didn't see a doctor but attached a wedding picture so they could see I was clearly overweight that year. I hope that's enough. I've been well overweight my entire life, so I can't imagine ever feeling and looking "normal". I hope it's enough.... I'm just inpatient haha.

[ldydrgnkpr 49]

Thanks for the response Vicki. I'm glad you were finally able to get your surgery done and you're doing well. I was told by 3 people that I do for sure have 100% coverage and the only requirement was "whatever the surgeon requires" is what they would always say. So I'm hoping with my high BMI of 49 it'll go through easily. The only thing I was missing was one year of medical records. I sent them 5 years worth, but I had nothing for 2006. I sent them a letter explaining that I got married that year and didn't see a doctor but attached a wedding picture so they could see I was clearly overweight that year. I hope that's enough. I've been well overweight my entire life, so I can't imagine ever feeling and looking "normal". I hope it's enough.... I'm just inpatient haha.

Good luck fingers crossed for you. Let us know when you get your date. I too have UHC but mine isn't PPO it's the other *** Choice. I have to complete the hoop jumping. The six month supervised diet, pysch eval, and last are the labs. So I'm half way through it. No biggie. Hope to be sleeved early next year. Keep us posted. How exciting for you.

[FuriosMommy 3]

Well great.... I checked in with United healthcare and they said my request is pending because they never received a psych eval or diet information from my doctor. The psych eval was done last month and I was told by 4 different people at United and by my surgeon's office that a diet wasn't required with my plan. If it is required I wish they would have told me a few months ago when I began this process so I could have already had a few months done. Ugh.... so frustrating. So I'm still not sure what they need and it doesn't sound like they are either.

[ldydrgnkpr 49]

Well great.... I checked in with United healthcare and they said my request is pending because they never received a psych eval or diet information from my doctor. The psych eval was done last month and I was told by 4 different people at United and by my surgeon's office that a diet wasn't required with my plan. If it is required I wish they would have told me a few months ago when I began this process so I could have already had a few months done. Ugh.... so frustrating. So I'm still not sure what they need and it doesn't sound like they are either.

Sorry to hear that. Did you speak with your case worker with UHC? I was told up front from my case worker what was required. Try that and call the psych doc office to see where the eval went. Sounds like the "right hand doesn't know what the left hand is doing." Let us know how it goes.

[FuriosMommy 3]

Thanks for the response. I was never assigned a case worker. I should call and request one. I have a phone call and voicemail in with my patient advocate at my surgeon's office so hopefully she can find something out for me. She told me she had my evaluation, so it's interesting that the insurance don't have it. I shouldn't get too shook up yet until I hear back for sure. I might get lucky and only need a 3 month diet... but I doubt it. It'll probably be 6. Guess we'll see. It was just discouraging to hear that out of the blue.

[MN Mary 0]

At my first visit to the surgeon's office I was told that my insurance company had several requirements to have a sleeve done. One was a BMI of over 50. Well here I go mine was 49.

The insurance staff at the office called my insurance company and wrote them a letter telling them that if I didn't have it done I would have type 2 diabetes. Also that my BMI would be 50 if we waited another year. She also went into other medical reasons I needed to have it done.

You may want to try to have your surgeon's office help you out. They know the ins and outs of the insurance game.

Also I send thank you notes to the staff that help me. The nutritionist, doctor, and insurance coordinator. I think the medical field needs to get some positive affirmations once in a while.

Mary

[FuriosMommy 3]

Thanks Mary, my BMI is also 49 and I'm pre-diabetic. I had hoped that'd be enough. Especially since the BMI limit is 40, but now all of the sudden they need diet information. I hope to find out more today. I've been waiting to hear back from my patient advocate, but she doesn't seem to be super on top of things =o( The thank you's are a good idea!