UHC Choice plus-won't cover?

[stacy73 2]

I just got a call from dr ofc- finally approved after 2 months of continuous phone calls to UHC-my surgery date is sept.5th.

[Jessie45 1]

:confused:I called UHC about a month ago, and the rep said Bariatric surgery is covered as long as I have A bmi over 40, was on weight plan with my dr. for at least 1 year, and had been obese for at least 5 years...

I called UHC choice plus today.. and they told me that lapband was covered as long as the surgeon called this in before the surgery. I asked the rep. if there was anything that I needed to send in, and she said "no..we have a box on our screen that says if u need to submit forms for approval and it has nothing in there, so you are good to go"

Has anyone else recieved totaly different answers from UHC? (I'm glad they assured me that the conversation was being recorded...lol)

[stacy73 2]

I know that the coverage depends on what your employer elected, but as far as I know the requirements are the same- 5 years documented weight history-over 40 BMI- if you meet this criteria your doctor needs to contact uhc- notify them of your intent to submit for approval-then they need to submit a letter of necessity along with your weight history for the last 5 years proving your BMI has been over 40 for the last 5 years- once they have this information they send to care coordination where they review it- if they approve this it is called a predetermination approval. They will call your surgeon give them a reference number and then at that point your are free to proceed with the surgery- i did all of my testing up front- I have UHC Choice and they paid for everything before they approved me.Do not believe the rep who told you that ridiculous info-you need initial approval which basically says you meet the criteria and that your policy covers the surgery. Hope this info helps. It took me 4 months to get approval.

[Fran 1]

Both GHI and UHC in New York turned me down. I self paid, and although it was tough, I am down 102 pounds since August 31, 2006 and am glad I did this. I now have an attorney for an appeal. Do it and you will not be sorry. Be well.

Fran

[Annie 0]

:confused:I called UHC about a month ago, and the rep said Bariatric surgery is covered as long as I have A bmi over 40, was on weight plan with my dr. for at least 1 year, and had been obese for at least 5 years...

I called UHC choice plus today.. and they told me that lapband was covered as long as the surgeon called this in before the surgery. I asked the rep. if there was anything that I needed to send in, and she said "no..we have a box on our screen that says if u need to submit forms for approval and it has nothing in there, so you are good to go"

Has anyone else recieved totaly different answers from UHC? (I'm glad they assured me that the conversation was being recorded...lol)

Each time I called, I got a different answer. Eventually though, I was approved and had the surgery in June. I have UHC Choice. Each employers plan is written differently...but if you meet the National Institute of Healths guidelines, you should qualify. My BMI wasn't over 40, never has been, It has been over 35 though, and if it's over 35 and have a comorbidity you should qualify. I did sumbit my last 5 yrs worth of weights that was charted each time I'd go to the dr for a visit.

Hope this helps. I know UHC can be frustrating, but have the surgeons office submitt the info to care coordination, and see how it goes.

[marywalker20 0]

Don't get me started on UHC. I have never talked to a more confusing company in all my life. My paper work was submitted the 20 something of June. I called on June 29 to make sure the paperwork was receiveed. The girl on the phone pulled up the paperwork and said "congradulations" you have been approved. I was so excited!! The girl told me to expect my confirmation letter in the mail in the next week. A week came and went and still no letter. I called UHC on the second week of July and was informed that I would not be getting a confirmation because on July 5th, they denied my claim because my BMI was under 40. Never mind I have 4 major co-morbidities which have all been documented along with letters of lap band recommendations. I am currently appealing the process. Since that time I have had to fax my appeal to 3 different machines until someone would admit they had it, even though the customer care people had been giving the fax numbers.

My advice to you is to recall, document names, and talk to supervisors. It's sad that we have to do this, but at UHC they treat you like you are mearly a number on a form. So sad.

Good luck and I hope you have been approved!

[Desiree1970 0]

I'm sooo peeved. UHC is now saying I owe them like 77K because they did not approve my surgery! Yet they approved my friend whom I work with and have the same coverage and same doctor... Argh!

[marywalker20 0]

Wow that royally bites! What I have learned from UHC is that they are very misleading. I would suggest that you appeal their denial for coverage. At the end of June my doctor submitted my paperwork, I called them on July 3rd and the girl on the phone said I was approved and should recieve my letter in the mail. I was soooo excited. Anyway, I waited and waited but no letter. So I called them back and they informed me that my claim had been denied because my BMI is under 40 even though I had 4 co-morbidities. I was mad!! I got all my doctors recommendations and test results and appealed. I called today and the girl told me that they overturned their original decision on July 27th and that I should get a letter of approval in the mail. Can't tell you how many times I asked if she was sure... Anyway, I won't relax on this until my letter.

Appeal the denial. It can't hurt and the paperwork is super simple. In fact if you go to myuhc.com, they have a link for appeals under "claims". Good luck and God bless!

Mary

[stacy73 2]

Mary, if you do not get your letter soon call your Dr.-they can get it online- uhc said they sent mine out on 7/17-still no letter-my provider never rec'd it either- they pulled it up online today and I now have a copy.

[marywalker20 0]

Thanks for the info. I am calling my doctor in the morning. I love this forum!

[BadGirlinFL 0]

Wow so many different stories about UHC. I have UHC Choice Plus as well and I have been told that our policy does cover the surgery 100%. I randomly call and ask over & over again just to be sure since I know that you get a different person each time you call. I also had the surgical coordinator call and verify I had coverage and each time I have received the same answer "yes" 100%. I have not submitted any ppw to my insurance company yet but I have my consult w/my surgeon on Aug. 13th and at that time they will submit my ppw. I have gathered all of my documents required by my insurance company so hopefully they will approve me the first time around.

[stacy73 2]

good luck, hopefully it will be a quick approval process for you!!

[marywalker20 0]

I hope my misfortune with UHC doesn't put a damper on your enthusiasm. We have had UHC for years and really this is the first time I have had a problem with them, so hopefully this is just a fluke. Good luck and I am sure you will be approved!!

[BadGirlinFL 0]

good luck, hopefully it will be a quick approval process for you!!

Thanks! I sure hope so.

[BadGirlinFL 0]

I hope my misfortune with UHC doesn't put a damper on your enthusiasm. We have had UHC for years and really this is the first time I have had a problem with them, so hopefully this is just a fluke. Good luck and I am sure you will be approved!!

No worries, I know each policy and case is different. I am going to remain hopeful that my exerience w/them will be short, sweet & simple