Is there a set order of things?

[2Big2Skate 328]

I'm covered by United Healthcare and they've told me they require 6 months of medically supervised diet. I'm doing that with the nutritionist at my Surgeons office (Dr Williams at UPenn in Philly). I've had all the tests done and no flags there, so I'm starting to get a little more positive this might happen!

My question is this. I'm a little hazy on the timing. If my nutrition program started in April then my MWL window would end in the sept/oct timeframe. Given that window, when would I get a surgery date, and would that happen before or after the request is submitted to UHC?

Thanks!

[JerseyGirl68 1,172]

The way I understand it, is after your 6 month requirement is complete (and any other requirements), they can submit to the insurance company. Depending on how quickly they turn it around you can approval as quick as a few days or few weeks. Then it is just a matter of setting the date with your surgeon. I have heard some folks putting a tentative date on the books pending insurance approval.

Good luck!

[Roserie 302]

They usually submit to insurance once you complete the program. For example, I had to do a 3mth program through Lehigh Valley weight Management. My last appointment with them was May 22nd. I went up against the review board May 30th. They approved me and then submitted to insurance and I was approved through insurance about a week ago. I met with my surgeon on May 30th and they scheduled my endoscopy for June 19th and my surgery for July 15th. This was the first available surgery appointment my dr had.

Edit to add that the Lehigh Valley Weight Management center has a review board that meets at the end of each month, could be different approval process for different dr's.

[2Big2Skate 328]

Thanks all for your comments and suggestions!

[NewAshes 232]

I started a thread the other day asking this. My first appointment is this Monday the 24th and my coordinator said I'm looking at surgery in December but going by that logic my 6 months would be tight and then the approval would have to go quick..she did say my insurance is a easy approval as long as I'm drug and tobacco free and complete my 6 months..I'm hoping to get it done this year so bad but it will suck to be healing during Christmas and New Years..

[2Big2Skate 328]

Just look at it like your Christmas present is a healthy new life!

[onedaycloser 136]

^Vixey,

^{I'm in the same boat as you are, so looks like we will be on this journey together!! I'm looking at this as MY Christmas present to myself..a better me, a better life!! We can do this!}

^{What state are you from?}

[cindymg 629]

I'm on United Health Care too. Went through the 6 month wait, but honestly I needed that time to get all of the pre-op stuff done (psych eval, upper GI, etc). And I needed to get my life/job organized so I could take a month off.

Plus, most importantly, I needed to make sure I was doing the right thing. Gave me a chance to read about 10 books about weight loss surgery, and talk to other WLS patients. When I went into surgery I new exactly what I was doing and what to expect.

That said, once your doctor submits, call UHC with a tentative surgery date. That speeds things along. Got the approval in about 10 days. And they were very nice, assigned me a nurse practitioner for follow up etc.

A note of caution: I had to delay my surgery for about 10 days for a work commitment. My doctor told me that UHC tried to cancel my surgery saying I had waited too long. Mind you, there was no time limit stated in the approval letter, so he was able to do the surgery, but I guess he had to really battle with them. So, make sure they don't try that with you!

By the way, just got the bill for the surgery --$44,000. My part is $250 and that's my co-pay for the hospital stay. I'm happy!