Still Waiting on Insurance - UHC

[Dani-X 0]

Hi there,

I'm still waiting for my insurance approval from United Healthcare for my surgery date of 10/23. The surgical coordinator said that they didn't ask for the 5 year health history (even though I have it) and she considered it a good sign.

There are no exclusions in my policy and I was told it was covered. I also heard that UHC is one of the easier companies to work with. For those of you with UHC, were you approved quickly or did it take some time?

She told me she'll contact them next week if we don't hear from them today and told me to start my liquids on Monday regardless. One of the reasons I'm so nervous is that my company may switchto a new plan on 11/1 and I'm afraid UHC won't approve me since they know our company might be leaving them. Any thoughts? Reassurances?

Thanks!

[tianealperry 0]

wow

im sort of in the same boat with Atena my company is switching in January so im trying to get the procedure done before then. i have my first appt with the surgeron on 11-10 so i hope things go quickly. and UHC PPO is who i want to go with. But my company is giving me a hard time they dont even know if the surgery is covered.

[Dani-X 0]

Hi Tia,

Have you called UHC directly? Before I even spoke to the doctor's office, I called UHC and asked them to see if it was written as an exclusion in my policy. They said it wasn't and that it was covered "pending clinical review." I asked for the representative's first name and last initial and wrote it down along with the date and time I called. It came in handy as I ended up giving it to the surgical coordinator at my doc's office when she was getting me approval.

I wouldn't wait on HR, I'd definitely give them a call as time is of the essence. Also, once you have your answer be sure to tell your surgeon's office about the impending insurance switch. They want to do the surgery with the insurance since that's how they'll get paid the easiet. I've heard that UHC is a DREAM compared to Aetna so run with it.

Good luck and please let me know what they say about your policy!! *fingers crossed*

[tianealperry 0]

i just got a call the my company has lapband covered but it would be just like you said clinial review. :ban: :D so im happy about that i guess ill will let my surgeon know about the changes and everything. it would be nice to get it done before the year is up but if it's a sure thing with UHC i'll wait until Jan.

Dani you really have helped me alot it seems that iam always thinking about how to get this surgery and its because i know i need help. UHC might just be worth that 77.00 per pay period!!!:cry

you rock Dani

how is the liquid diet thing going for you

[sheilamj1fan 2]

:clap2: Wow that is great info Dani!!!:clap2: Hello my name is Sheila and I have UHC, I'm hoping my approval journey is not going to take long. I feel it won't, but I called my primary care physician on 10/27 and 10/28 to get my medical record and a letter from regarding WLS. However he stated he will not give me one until he see me, because we have never discussed WLS...but he just saw me six months ago:mad:. Is this normal? I am thinking about finding me another doctor, but I don't want to waste anymore time. Anyway, I went ahead and made an appointment for 10/30. I will meet with the surgeon on 11/3 for my first consultation. I have it set in my mind that this is what I want to do and I pray everything will work out. I would like to have the surgery if at all possible, by Thanksgiving or definitely by the second week in December. I hope you doing good Dani and good luck Tia!

[MS_mom_1965 0]

I currently have BCBS, which says I have to have been under a Dr.'s care for obesity for at least 1 year. I only have 6 months.

My company is switching to UHC in January. How strict are they with the 5 year doctor's obesity treatment clause?

[myturnow 0]

good luck with the ins. approval.. I am also in the process.. I have met the surgeon and have apts. for the nutritionist and head doctor.. I am a little anxious. But definately need help getting Portion Control into my life.. A couple of people at my work have had or had their spouse get banded. They got approval and had it paid for... so I feel pretty confident.. I have been with a diet center for six months and lost 25lbs but staying the same for weeks and still working the program.. hanging on bearly... so I need this tool if I ever will be successful I am new and looking forward to all replies and feedback.. because ITSMYTURNOW!!:clap2:

[christina c 0]

I currently have BCBS, which says I have to have been under a Dr.'s care for obesity for at least 1 year. I only have 6 months.

My company is switching to UHC in January. How strict are they with the 5 year doctor's obesity treatment clause?

Hi, I have UHC and have had them for the last 6 years. When I called they told me that I had to have a BMI over 40 and have had to be obese for over 5 years. Well, I did not meet those requirements. I found a great Dr. Dr. R Vohra in Hewlett, NY. His staff is wonderfull. I started all of the pre op testing and found out that I had/ have sleep apnea. In the recommendations from the sleep apnea group was a restrictive weight loss prgoram through a Dr. This is how my Dr. was albe to get the surgery approved. I also had all of my Dr's write me letters of medical necessity for the surgery. This helps as well.

my pre op info

BMI 36 weight 204 lbs, only 5'3

tried everything and could not lose the weight. I had my surgery on 11/2/06 - 2 days banded, Good luck

[MS_mom_1965 0]

So if you have other conditions, the 5 year thing can be waived?

I have high blood pressure, maybe that would count...

[CheriCline 0]

I have major back problems, 2 herniated discs and nerve damage from them. I also have gastric problems, like serious acid reflux. I am hoping that it might help my cause. I pray for more medical problems, if that sounds crazy. I want to get approved. Maybe I do have sleep apnea and do not know it. I just don't have a five year history of obesity. I am scared I am going to be denied and be fat forever. It is hard. I am so young. I just turned 30, and I would like to have kids one day. I fear I won't be able to run around after them and be the best mom I can be. Will my other medical problems help my cause when it comes to insurance?

[christina c 0]

I have major back problems, 2 herniated discs and nerve damage from them. I also have gastric problems, like serious acid reflux. I am hoping that it might help my cause. I pray for more medical problems, if that sounds crazy. I want to get approved. Maybe I do have sleep apnea and do not know it. I just don't have a five year history of obesity. I am scared I am going to be denied and be fat forever. It is hard. I am so young. I just turned 30, and I would like to have kids one day. I fear I won't be able to run around after them and be the best mom I can be. Will my other medical problems help my cause when it comes to insurance?

I know how your feel. my L4-L5 L5-S1 is herniated and i am unable to walk/stand for any length of time. I am constantly in pain. i see a pain mgmt Dr. Who originally was the one who brought this banding to my attention. Otherwise, I never thought to be a candidate for it. I saw several surgeons, who said I would have a hard time to be approved. Which was fine, because I did not care for any of them any way. When I found a Dr. That I like, and he happened to be in my UHC Network, I was happy. His insurance administrator told me to complete all of his pre- op testing to see if I am a candidate, then we will worry about ins. I went through intense counseling, nutritional, cardiovascular, sleep studies, pulmonary, gastro. Everything came up perfectly fine except, they found that I had Gall Stones, which my Gall Bladder was removed on 10/4/06, Then I was told that I had Mild obstructive Sleep Apnea, who would have known? With the sleep apnea, proof of dieting on my own and w/ my Primary Dr. as well as letters of medical necessity, I was approved. If you want private message and we can see if any of the things I did can help you. My approval took 1 week. Good luck Christina

[StephC 0]

Hi - I have upmc - I haven't met anyone else on LBT with upmc and would love to talk to someone about it. I went through the whole 6 months, all the preop tests and now its just the waiting for approval. I called my insurance today and they said they hadn't received anything, so I called my doctor and he said the had just sent them on Nov. 1 and we should give it a few more days. I had really been hoping to have the surgery before thanksgiving but may have to wait a little while longer. The 6 months didn't feel as agonizing as this month. Anyone else out there have UPMC?

[hamiltonpaula9 0]

Hey everyone, I have uhc, and i am waiting to be aproved, i was call in for my pre- op , and waiting on the approver and if i am approved i will have my surgery 12/11/06 if not i will have to wait until Jan07, Please send me some support i am nervous about the insurance part, everyone seems to say uhc is the best, but i guess we'll see, my bmw is49

[ousooner 1]

I had/have UHC. I was approved and had surgery 5 weeks to the day after my innitial consultation. I think it was like 2 to 3 weeks for the approval to come in. It was a very seamless process for me. When I changed jobs, I was glad to find out that my new company also has UHC.

[sheilamj1fan 2]

Hi I have UHC and I am still waiting for approval!