United Healthcare Choice Plus Of Nj

[serenity28 0]

Hi I am new to this forum and i am thinking of getting the VSG. I wanted to know anyone living in New Jersey, who has this insurance and what were the outcomes ectra.Thanks.

[Misstxdiva 73]

I don't live in Nj but I do have United Healthcare Choice Plus here in Texas. My employer purchased the bariatric package so it was covered. I had to do 6 month supervised visits with nutritionist and surgeons office. Labs, X-rays and psych evaluation. Started the journey October 2011and was sleeved April 10 2012. Good luck and congrats on your decision to pursue VSG.

Sent from my iPhone using VST

[serenity28 0]

Thanks!

I just hope i have no snags. Does anyoone know if a person can be approved by the doctor stating medical necessity. I mean that has to do with the person's life health . I am 5'6 252 High blood pressure. BMI 41 isn't that proof enough?!

I have a consult and i am sooooooooooo anxious and nervous all rolled into one!! I just want to be healthy that is what matters to me most!

Has anyone who lives iin NJ had to appeal UHC choice plus?

[change 22]

Hi serenity28, I live in NJ and have United Healthcare Choice Plus too. I consider my approval process fairly easy.

For me all I had to do was call United Healthcare and open a case. I was then called by a company that United Healthcare uses to assist with the Bariatric Surgeries called Bariatric Resource Services. I was assigned a nurse by them and she called me and asked me a few questions and let me know exactly what the requirements for my Insurance were. (I've read on here that many individuals requirements vary even with the same insurance. It depends on the policy that the company you work for chose.) My requirements were 6 month supervised diet, must be older than 21, BMI must be 35 or greater, and Psych evaluation. (I also am required to use a Center of Excellence)

My surgeons office submitted all of my paperwork on February 23rd and received an approval call by February 24th!! My surgery is scheduled for May 15th. Hope all goes well for you!! Keep us updated on your experience.

[serenity28 0]

Congrats very happy for you!!

I was calling the office lol and they told me that when i come in for the consult i would be then, meeting with the Dr. and the Insurance specialist.

From there there the specialist will let me know and to bring in forms that i have to bring. What i did was find a place then proceeded to get an appt..

I just hope all falls into place!!

Keep me posted !

[change 22]

That is awesome!

Just a suggestion, Do you know if that doctor accepts your insurance? It is up to you, but I would suggest calling the insurance and seeing if they require the center of excellence like mine or if they use bariatric resource services just because doctors visits (especially meeting with the surgeon) are not cheap at all! So you don't want to meet with this surgeon and have to pay for that visit only to find out your insurance does not accept him.

I guess what I mean is at least maybe you can go on www.myuhc.com and set up your acct and then check to see if the surgeon you chose is "in network"

Hope that helps!! Wish you the best with everything!

[serenity28 0]

Well I was told to fax them the card, in which i did few weeks ago and that is when they called me to say when my appt would be for the consult . Which is the 4th of May. Since the doc was going to be out of town.

[change 22]

O okk thats great!! Then you should be ok. I'm sure they would let you know if your insurance didn't cover that doctor. Wish you the best!! Good Luck!! Hope everything falls into place for you

[serenity28 0]

Oh i forgot to say that when i called to find out where they were located ectra. she asked me who my who was my GP? and i told her and it seems they know who she is.Does it make any difference? Thanks!

[change 22]

I'm not too sure about that. Sorry I can't be of more help but I don't think that should make a difference. I'm sure all will work out for you. Be sure to keep us updated!

[serenity28 0]

No problem. You have been very helpfu !!

[serenity28 0]

Well an update. I called UHC and they told me they DON'T cover this procedure. So I emailed the office where i was going to go for my consult. I ahve heard nothing thus so far. What the UHC rep told me was to call HR at my DH's job but the perosn was not there. I knkow every November you get a chance to enroll in another insurance policy But like the UHC told me it depends what the OWNER of the company would put in.

So, i don't know if these people at he consult would help me appeal it as i knkow many people have gottne thru to it with that.

I also asked about teh Center of Excellence which is true ..though for people who already have a policy with the procedure.

I am jsut praying something comes out good out of this. I am 5'6 253lbs. HP .BMI 41.6 . So I pray things turn out better.

[serenity28 0]

So i get n email from the Patient Coordinator telling me that if a patient has a very high BMI I am a canidate. So she set me up for an appt for the 26th she moved it forward from the 3rd of may.

Anyone out there in WLS land think this is a positve foot forward into the RIGHT direction?

I jsut have to fax her the forms she sent me last time and the ngo in for the consult.

any feedback please let me know!

Thanks

[change 22]

Sorry to hear that serenity I completely understand what you mean.

I originally had UHC in 2009 through my job however my job had placed a clause for the weight loss surgery and so they would not cover it. When I found out my husband had United Healthcare as well I was upset because I thought UHC did not cover it in general, but that is when I realized that every company can choose what to cover and what not to cover when signing up with an insurance provider. Thankfully, my husbands UHC did not have a clause to not cover WLS.

Don't let this stop you from pursuing the sleeve. When I found out in 2009 that my insurance had a clause I just gave up on having the surgery and here I am 3 years later still in need of this wonderful tool!! I wish you the best! Don't give up! There are so many hoops we have to jump through to have this done but I believe it will be all worth it!!

Keep us updated. I will keep you in my prayers. I hope that everything works out for you.

[serenity28 0]

Well the coordinator called me just a few minutes ago She said if the insurance won't budge to pay...then she can refer me to self-pay companies that will help me with the payments. I don't think dh will likely go for that! At the moment i am unemployed yes it sucks!!! I really am stuck ...here

i need to change want to change but I have no clue what to do. I am sooooooooooo frustrated it is not even funny!!!