UHC and the 6 month "failed diet" attempt

[Crabadams72 20]

Hello VSG world!.

I have UHC (Gov't Employees Health Assn) PPO.

In the literature for bariatrics they state that you must have a 6 month failed diet attempt.

Does this mean you are not supposed to lose weight at all or that they consider losing 10 pounds in 6 months a failure?

I am right at 40% bmi. My co-morbidities are Gerd,Joint Pain, Family History (mom and sister) of diabetes, heart disease and hbp,hiatal hernia.

I did email the UHC coordinator but she did not give me a clear answer on if I can lose a few pounds or not. She just said it "should" be ok.. Sorry but "should" does not sit well with me in insurance situations.

Has anyone on here been denied for going below 40% with minor co-morbidities?

[TijuanaPlication 87]

I was self pay, so can't speak from personal experience, but I did read of someone on here who only just qualified for surgery, did their 6 month diet and lost some weight and then was no longer eligible, as they were below the minimum BMI!! Hopefully someone can give you some good advise on how to deal with UHC - good luck.

[ldydrgnkpr 49]

Do you have a case manager? If so she should be able to answer your questions. I have UHC and What I was told was, Your inital height and weight is what they go by. So if your doctor documented your height and weight and your bmi at the initial visit that is what they go by. But every policy is different. Double check. My initial bmi was 41.3 no comorbidities. Which is what was submitted by the surgeon. Was approved like in no time.

Deb

[Rootman 1,101]

Well I personally know of one person who was losing weight on their 6 month prescribed diet and was told on the sly by their NUT that if they continued to lose weight they would become ineligible, they were over a BMI of 50 too. He was "advised" to not lose weight but not to gain to much else they be deemed psychologically unfit due to food addiction. He meaintained weight and the final weigh in was within 5 pounds of his first weigh in.

It CAN be a real crock if the insurance company decides to use it as an excuse to deny people.

BEWARE that I am NOT advocating gaining weight or not being honest during your diet.I am merely sharing someone's experience.

[M2G 1,836]

I too had UHC and a Nurse Case Manager (the ONE who decided yes or no) and also a Bariatric Case Manager who was more accessible than the nurse. But I did ask my Nurse specifically what happens if I lose weight and she told me since I had no co-morbs, then my BMI at my FINAL 6 month checkin would be the BMI used to determine eligibility. My plan stated >35 with the presence of co-morbs, >40 without any.

I really wasn't at risk of going to low (my BMI was 44) but I didn't lose a single pound over the entire 6 month journey (plus my surgeon didn't require me to lose any weight either) and was approved for surgery after submitting all documentation at the end of my 6 month weight "monitoring" period.

That is just my experience, you need to find out SPECIFICALLY what YOUR plan outlines. Keep calling until you get an answer, and preferrably from the PERSON who will actually decide your case.