United Healthcare requirement

[peacequeen 434]

I have United Healthcare ChoicePlus and have been told to qualify for surgery that I must have a 5 year consecutive record of a bmi of 40 or higher. I'm curious to know if anyone has been approved without meeting this requirement throught UHC? I'm concerned I'll be denied because I've only had a bmi over 40 for close to 3 years but have had one over 35 for 8 years..and over 30 probably my whole life.

[Tony666 0]

I have UHC and have a BMI higher than that, but I also have a ton of comorbidities. I really had no requirements other than the Psych consult and the Nutritionist visit. Good luck!!

[peacequeen 434]

My bmi is close to 48 now, I have a ton of comorbs too but if they require that bmi history..I'm in trouble. Even though my weight has always been up, long term prednisone set my weight soaring to raise my bmi this high. Now I'm off of them and can't get the weight off. My doctors are supporting the surgery so I hope that will be enough.

[BamaXpress78 21]

I have UHC ChoicePlus as well but after spending an hour on the phone earlier this week and being transferred to 7 different people in different departments I still don't know exactly what my requirements are. No one could tell me anything other than it is on my policy and what the coverage pays toward it. I finally gave up and just told the administrator at my surgeon's office that I'll wait for her to get that info back from my insurance.

As far as the 5 year BMI, do you have any comorbidities? I would think that if you do then the BMI requirement may only be 35. Even if you don't know about any now I would do the sleep study because most overweight people suffer from sleep apnea whether they know it or not. Anyway, good luck with your situation I hope it all turns out in your favor.

[ldydrgnkpr 49]

I have UHC Choice Plus and I didn't have to submit a five year history. However, depending on which plan your employer has will determine what you will need to submit. I had to call the 800 # on the back of my card which they gave me the 800 # to the Bariatric Resource Service to "enroll" which I received a case manager who in turn reviewed what critieria I needed to meet. For my policy I had to complete a six month supervised diet and exercise, psych eval, have a bmi over 40 and a letter from my PCP. Once I completed those requirements the surgeon submitted all of my paperwork to my UHC case manager. Best thing to do is to call and see if there is a number to put you in contact with a Bariatric Resource Service Rep. They are the ones that deal with the ins and outs of your policy for Weight Loss Surgery. Good Luck with everything.

Deb

[peacequeen 434]

Thanks for everyones response.

Bamaxpress78, yes I have comorbs. I have an autoimmune disease called Myasthenia Gravis, it's in the muscular distrophy family..complicated. Anyway, I do have sleep apnea and use a bipap for my MG but it also helps for apnea. I am prediabetic (would be diabetic if i was still on steroids), anemic, osteoarthritis and malacia, hashimotos thyroiditis..so on and so on... I also have a level of anxiety and depression due to my list of health issues. I currently carry a bmi well over 40 but if UHC has that requirement to be morbid obese for 5 full years, I fail that, I was just severe obese before that...how dare me!

ldydrgnkpr, I did call them and they told me I had to be over 21, have a bmi of 40 or above, a list of 5 years 40+ bmi. No diet to follow though. I guess what I'm wanting to know is how strict that 5 year bmi rule is,,has anyone been approved without meeting it?

[2sweetnsugarland 9]

Thanks for everyones response.

Bamaxpress78, yes I have comorbs. I have an autoimmune disease called Myasthenia Gravis, it's in the muscular distrophy family..complicated. Anyway, I do have sleep apnea and use a bipap for my MG but it also helps for apnea. I am prediabetic (would be diabetic if i was still on steroids), anemic, osteoarthritis and malacia, hashimotos thyroiditis..so on and so on... I also have a level of anxiety and depression due to my list of health issues. I currently carry a bmi well over 40 but if UHC has that requirement to be morbid obese for 5 full years, I fail that, I was just severe obese before that...how dare me!

ldydrgnkpr, I did call them and they told me I had to be over 21, have a bmi of 40 or above, a list of 5 years 40+ bmi. No diet to follow though. I guess what I'm wanting to know is how strict that 5 year bmi rule is,,has anyone been approved without meeting it?

I have the exact same insurance and I had comorbidities also. I did NOT have to submit a 5 year summary of my trying to loose weight or any other stuff like that. I met with the Davis Clinic in Houston, TX in April, attended the psych session, attended the NUT session and was sleeved on 5/13/2011. Hopefully it will be as easy for you as it was for me.

[Kristy 90]

I as well have the same insurance..I had to submit a 5 year history of obesity, not just BMI, they want a weight log from my PCPas well..

[Deliah 0]

Well I have United Healthcare also and yes they do require that but do you have any co morbidities? If you do then you will also qualify and 2 of the 5 years i was not over 40 either and I just got approved!!!

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I have United Healthcare ChoicePlus and have been told to qualify for surgery that I must have a 5 year consecutive record of a bmi of 40 or higher. I'm curious to know if anyone has been approved without meeting this requirement throught UHC? I'm concerned I'll be denied because I've only had a bmi over 40 for close to 3 years but have had one over 35 for 8 years..and over 30 probably my whole life.

[peacequeen 434]

Thanks, Deliah! That's promising news. Yes, I have comorbs..several. I also have 2 letters of referral from 2 of my doctors. I have a weight history a mile long, just my bmi hasn't always been over 40 within the past 5 years. My doctor told me the national bmi standard is only 35 so UHC shouldn't try to come up with their own rules but it's probably my husband's employer that has this requirement..don't know for sure. Thanks you guys!

[LeaveItToSleever 80]

I have UHC and have a BMI higher than that, but I also have a ton of comorbidities. I really had no requirements other than the Psych consult and the Nutritionist visit. Good luck!!

Same here, but I've spent enough time reading threads that I am still scared that insurnace will deny me at the last moment, even after jumping through all the hoops.