UHC Choice plus-won't cover?

[TulipStar 2]

UHC has finally approved me after 11 weeks!! It was a rough ride... and I didn't have a BMI over 40 for all 5 years (only 3 of the 5). But my dr office was great at dealing with them.

My previous experience with UHC has been poor. Their reps on the phone don't know what they are talking about and you get a different story every time. For me, I found it was better to completely ignore them and NOT contact UHC bc they tell me the wrong things. I called my dr office every 2 days and they would give me an update on the status of my case.

[BadGirlinFL 0]

UHC has finally approved me after 11 weeks!!

CONGRATULATIONS!!!

:gluck: ON YOUR UPCOMING SURGERY!!

[gingerbug 3]

Hi! This is my first post here. I read the entire thread - we have UHC choice plus and am planning to call my care coordinater in the morning to find out what I need. All the customer service rep could tell me was morbid obesity was covered but no details. He said something about 35% BMI and 40% bmi as well as 5 years so on so forth. I need to figure out what I would need for 5 years - I have access to my medical records - my mom is an LPN at the clinic I always went to. Do they need to be the actual medical records? Can it be a letter from my doctor or some compilation of my weight over the last 5 years? I was also seen at the same clinic for my pregnancies but Idont think that would count! Any advice on how to best prepare for submitting to insurance would be greatly appreciated!!

[stacy73 2]

i have uhc choice also- for the weight history they just need notes from your chart documenting your weight for the last 5 years- they do not need detailed records or anything like that- your surgeon will list all you comorbidities when they write the letter of necessity- but basically if you have 5 yr weight history and bmi over 40 techincally you should be covered..

[Ready4it 0]

My mother (she is doing lap band as well and I am her dependent) called today and found out that we just need a letter from our PCP (shouldn't be a problem, seeing him very soon!) and then it should all be a go! I am so excited about this. My BMI is well over 40 and everyone in my family has high BP, some have sleep apnea, etc. I am so excited to progress to the next step! I just need to fill out some things for my surgeons and get some labs done, have my psych evaluaton and see what they say!

UHC has always been so good to me, which doesn't seem like the normal thing around here, but it has. I've had quite a few medical issues in the past month and a half and they've been nothing but wonderful.

[marywalker20 0]

Congrats ready4it!! Glad to hear that you had good luck with UHC!! And even though I am one of the ones that had problems with UHC, it's nice to hear about some good experiences also. Too often we complain about our problems but fail to report the good things about insurance companies.

Good Luck!!

Mary

[bigez1 0]

Did your policy exclude any weight lose surgery, or did they just refuse you?

My policy says its excluded.

[marywalker20 0]

Hi Bigez1

Not sure who you directed your question to, but here is my 2 cents worth. The first time the doctor submitted my claim it was denied because my BMI was under 40. Our insurance company does cover Lap Band surgery if you meet their criteria. However because I have multiple co-morbidities (sleep apnea, partial and then total knee replacements, high cholesterol, and a history of heart disease. We appealed and sent along recommendations from my doctors and I was approved right away.

What UHC explained to me was that each employer has the option of whether or not they want to cover the WLS for their employees and families. Guess it's all cost driven. Luckily my husbands job covers this.

Best thing would be to call UHC and ask if you insurance policy has this rider and if it does what percentage do they pay. Our policy covers 80%.

Good luck and i hope this helps. And hope I didn't but in where I wasn't supposed to.

Mary

[bigez1 0]

i do have problems and family history. I am 6'4" and 450 lbs, i have an artificial hip and im borderling diabetic, high blood pressure, my BMI is over 54. I know I more than meet the qualifications.

My concern is if it is even possible to get an excluded medical procedure covered. Has anyone actually done this. I have UHC and my policy says WLS are Excluded.

[blushn 0]

I have UHC choice plus and when I called them last week the woman told me on my plan that the only thing I would have to pay is the $150 hospital co-pay. I have no deductible and as long as the facility is in network then they cover 100%. I sure hope that is true and nothing changes.

I'll probably call them again and see if I get the same answer. My surgeons office is submitting all of my paperwork next week (just waiting on one report) and hopefully I will get a date after that.

Anyone else have their UHC Coverage through Cablevision here in the Northeast ever have an experience with them?

[Chica30 0]

Hey all! I am a new registered user, though I've been browsing for awhile. I have UHC Choice Plus 250, and I am still awaiting approval as I write.

From what I've read, no two policies are alike! Which of course is frustrating and somewhat irritating for us I am sure. My company's policy states that any weight loss treatment, surgerical or non, is NOT covered. Of course when LifeWeigh Bariatrics called in they said if it is deemed "medically necessary" they will cover 80% of the procedure. What a difference in stories, no?

As of last Tuesday my claim made it past predetermination, and now is awaiting approval :clap2: or denial :faint:from the pannel. I am to call back this coming week to see if any progress has been made. I was told by the surgeons office as well as UHC that usually this type of approval takes 30 days. I think that is a bit ridiculous after reading some of you being approved in a matter of days. But what can I do but be patient and hang in there.

I am starting to doubt if the procedure will be considered medically necessary for me due to my age and overall good health. I have a BMI of 49, I am 24 yrs old, have consistently had a BMI of over 40 for over 5 years (try like 12), and with the exception of back problems I am in excellent health. That is what worries me. If I keep this weight on I know I will not always be healthy. My parents are prime examples. Both have BMIs of 40+ and Type II diabetes. No thanks, I don't want that for myself. Anyhow, I see that all BMIs, ages, and co-morbidities have been approved and denied. I am trying to stay neutral on the idea so as not to set myself up for disappointment if they deny it. It's something I know we all face.

I guess I am just looking for some common bonds with others who are going through the same process. That's what forums are for, right? No one else in my life is as large as I am (including parents), nor wishes to change their life as much as I want to. If all goes as planned I should be banded sometime in September. My personal goal is to be down 60 lbs by my 25th birthday in March. I am supposed to go to Belize in late Feb, and it would be nice to fit comfortably on the flight down, and to break out old summer clothes that I haven't worn in over 3 years. Crazy to think about it. Ultimately I just want to be out of the danger zone and fix my back problems. I also want to be able to have children someday, and carrying extra weight might inhibit me from doing so.

I wish the best of luck to everyone waiting for approval and hope your lap band wishes come true!

Anyone in IL currently awaiting approval? If so, who is your surgeon?

[Chica30 0]

Just spoke with UHC today and I was approved! This is the best news ever! I got a confirmation number and had my surgerical office contact them as well.

Lap band here we come!

[marywalker20 0]

CONGRATS~~~~ Chica30! You are on your way!!

[blushn 0]

Congrats Chica that is great news. I spoke with my Surgery Coordinator today and he told me that he will be submitting all of my paperwork to UHC no later than Thursday this week. I hopefully will know soon after that.

[HappyCamper 0]

I have UHC Choice Plus and I called them to ask if LapBand surgery was covered and they said yes. If I went to an in network surgeon they covered it 90% and in network hospital is covered 100% after $100 deductable. If I went to an out of network surgeon or hospital, they covered 70% Well my surgeon was out of network so I had to pay 30% of his charges, but the hospital was in network so I only had to pay my $100 deductable.

I was approved very fast. My surgeon's office just sumitted a claim to UHC for my initial consultation. While I was in the process of trying to obtain my medical records for 5 years of chart notes stating my weight,

I received a letter from UHC saying I was approved. I couldn't belive it. I call my surgeons office and they called UHC to verify, and yep I was approved. I couldn't believe was easy it was. It was 7 weeks from my initial consultation to my surgery.

I wish you all luck and hope you are all approved soon.