UHC Choice plus-won't cover?

[CoolBrze198 0]

:help: I will be right there waiting with you. I have a PCP that doesn't believe in WLS. I a trying to get an appt with him and see if I can get his letter to say that I am healthy & approved for surgery... But that looks like that won't be till June.. Grrr.. So I am looking for a new PCP before I can submit everything. Then keeping my fingers crossed..I would hate to start over and find a new PCP.. I think all is ready to go other than PCP approval & submitting to surgery... how aggrevating is that. I have my Psych eval scheduled. Time for the count down. Looks like I will be waiting on PCP clearence... Grrr.

Anyone have any ideas on some local PCP's in Lakeland or Plant City---Florida:help: :faint:

I will be thinking of you all Keep us up to date with your journeys.

:clap2: :clap2: :clap2:

[horns10 0]

I have UHC Select plus POS - I just found out today mine is being covered 100% minus the normal co-pays ($15) for pre-op visit and myocel shakes.< /p>

[Amelia40 0]

I have UHC Choice Plus and mine was covered 80% plus co-pays. My aprroval cam within a week of everything being sent in. Just after mine was sent in I receved a phone call from the nurse with UHC. She said she was calling just to touch base for the new year. Anyway I found out later that she is also following up with me regarding how I am doing after surgery. I also found out that the pshyc evaluation was not need by them for approval. So all I need was an interview with the pscologist and as long as he felt comfortable making a recommendation for the Dr he accepted this.

Good luck to everyone. I believe it really depends on the plan benefit employers have selected.

[Annie 0]

From what I gather from UHC, it's covered 100%, other than my normal co-pays. So I'm not worried about that part.

I'd like to know if there are any others here with a lower BMI that had any troubles getting approved for the surgery by UHC? Those of you who got approved fairly easy, what are your weights/co-morbidities, etc?

Cool Brz, I too worry that my PCP won't "approve" of the surgery, we've talked about it in the past, and she didn't seem to much of an advocate for that kind of thing...I am hoping to get this all approved without having to ask her...isn't that terrible, she's going to know eventually, but It's just another thing to make me feel like a failure ya know?? And changing docs isn't a choice for me. I know, it's not right....

[pamla68 1]

I have UHC choice plus EPO. My pcp approved me back in February. My pressure, back, and ankles are my complications. My BMI was 42.4 when paperwork was submitted (since I began working out it has dropped to 41.5) UHC received the paperwork from the surgeon on March 3rd. I called on March 19th and they told me to allow 30 days. :mad:

Yes or no is sufficent. What are they looking for?

[Annie 0]

Pamla,

I wonder if that is normal, them taking that much time to review....

[pamla68 1]

Pamla,

I wonder if that is normal, them taking that much time to review....

Probably. I just got off the phone with my HR benefits manager who explained to me I have HMO Choice which bariatric surgery is covered 90%/10%. So I will wait.

[Annie 0]

Probably. I just got off the phone with my HR benefits manager who explained to me I have HMO Choice which bariatric surgery is covered 90%/10%. So I will wait.

Well, good luck to you! I'll say some prayers for ya! You'll have to keep me posted on how it goes. :mad:

[396power 2]

I'm new to this site I went to initial appt. on 03/12/07 and lab work and stress test on 03/13/07. my wife went today. my bmi ig 44 hers is 42. I have really no known health issuies she has sleep appnea. we have uhc and was wondiring how long the process takes and if uhc normaly covers and just basicaly what to expect. we went through lapband souloutions in houston thank you

[spectacularone 0]

I was denied by UHC Choice Plus with a 38 BMI and no real co morb. except sleep apnea, but no sleep study. Our plan clearly states that it's a covered benefit "when medically neccesary" and that's the trick--figuring out what some "review panel" beleives to be medically neccesary.

I am in the process of appealing now with one of the attorney's. It did take 30 days for them to send out a denial letter. Here's what stinks about UHC is each time I called I got a different answer or told to call back in two weeks!

My denial letter was VERY vague. Not deemed medically neccesary but no reason why it's not deemed medically neccesary. Just that sentance and no more.

After all that I had to order my complete medical records and THAT took 30 days and get a copy of my insurance handbook from my husband's employer another 10 days and then hand all of this over to the attorney and who knows how long that'll take. I REALLY wanted to be thinner for summer. If this doesn't work out, I'm going to fly to Denver and have it done by Dr. K ($9950) and pay cash. My husband is just very concerned that if I have complications heaven forbid that it would wipe us out financially. That's my main concern and why I'm fighting so hard to get it covered.

I've read about people on here who turn right around after being denied and resubmit and then get approved? I wonder if I should try that if this appeal doesn't work.

[Annie 0]

Spectatularone! I too have gotten a different answer each time I've called UHC....The first call seemed very promising, that's why I really started tp persue this. I've called them 3 more times, and each time I get a slightly different answer, each one sounding less likely it would happen.

The last call, the lady was soooo rude, she actually said "I can't help you". She stated that it's all up to care coordination....that she couldn't tell me anything that could help this process along.

I couldn't believe that she said it that way. Isn't their job to explain these types of things to us??? Hopefully my surgeons office will have better luck than me.

Is your insurance plan for federal employees? I hear they are usually easier to get approved for some reason.

Also, I'm hoping with my high blood pressure it will be enough. I have a strong family history of diabetes and heart disease also, so I hope that helps them deem it medically necessary.

[spectacularone 0]

They can be RUDE! One girl told me I was "lucky" they covered this proceedure at all since it's totally elective.

I should've reported her but didn't have another 30 minutes to be on hold that day.

My husband works for Chase so it's not federal but we chose this insurance BECAUSE surgery was covered if "medically neccesary" then to get declined with no reason sated was a shock.

Like you--each time I called I was assured that it was covered and it wouldn't be a problem. One day they told me since it was out patient that I didn't need approval at all! Then BAM, denial letter in the mail.

I hope this attorney can make some sense of this. I started all this in December and have stayed on top of it and I still don't have any real answers.

[Annie 0]

Spectacularone,

Well, I just spoke to the surgeons office, have my evaluation appointments set up for 24 Apr. Wish it was yesterday! LOL! I am really impatient, and I'm ready to do this now!

Anyway, i told her of my concerns with all the different answers I have gotten from UHC, and she told me to call them back and ask to speak to a supervisor, that I should as them if there are any exclusions, and if I have to be on a supervised diet for any length of time before they approve it.

Hopefully not, cause I don't want to have to wait 3-6-or 12 months to get this done.

I'll keep you posted.

[pamla68 1]

Does anyone know if UHC care coordinators post their decision on the personalized website at www.myuhc.com?

[Bikergirl 0]

I don't think they post them - they send a letter letting you know you were approved. After I received mine I faxed it to my doctor on a Monday and was banded on Thursday.