United Health Care Optum

[desig1814 17]

I'm pretty new to this but I have United health care insurance thru Best Buy. It says I have to do a 6 month surpervised plan but my surgeon said no. Does anyone have experience with uhc or Optum. My Optum nurse & I have been plaing phone tag for weeks!

[TurnThePage 220]

Yes, UHC requires the 6 month program. Your surgeon's staff is probably making the same stupid mistake mine did, almost costing me my surgery. They call the ins. co. for a verbal verification of the requirements and get stupid answers from ill-informed people at the phone banks, rather than taking the time to read the official UHC Statement of Medical Policy in their files. Below is the link to UHC's Statement of Medical Policy on Bariatric Surgery which gives their requirements for surgery. I received it from a UHC employee during my appeal. Note the bullet points near the bottom of page 3, but read the policy so you get the big picture.

My ins. administrator relied on a verbal check of UHC's requirements with some clerk at their 800 number, instead of reading the document in her file, and didn't tell me about the 6 month requirement when I started the program. Upon completion of my class work, they submitted my request for surgery. I was approved by the contract manager for UHC and then 2 days later, UHC revoked the approval when they reviewed the file. I went ballistic and ultimately involved the medical directors at UHC and the contract manager as well as the COO of the hospital that owns the bariatric center and a lawyer. It took 45 days, but I finally won my appeal with records of a past 6 month program years ago. You might not be so lucky if it happened again. Be sure you get very clear written instructions as to what is required for that 6 month program to avoid the problems I had. Keep very complete notes of all conversations, including names, phone nos. and dates. Send me a PM if you need more help.

https://www.unitedhe...ric_Surgery.pdf

[desig1814 17]

Thank you so much! I most likely will be asking you foe more info. I really need to talk to that stinkin nurse to get exact answers. I'm already ready to wait 6 months but I just don't want to do the wrong thing for 6 months.

[Jacqueline K 93]

I have UHC as well through Wells Fargo. I did not have a 6 month requirement. I had surgery 2 months after my initial consult. Only requirement I had was a mental health evaluation and to use a bariatric center of excellence. It will all depend on your individual plan. Good luck.

Sent from my iPhone using RNYTalk

[stasea4 41]

I have uhc thru Jcpennys an I didn't have to do the 6 months Weightloss an they approved me in 3 days from papers being submitted to them an my sugens office had to call n change it from sleeve to rny cuz I changed my mind after read up on everything

[desig1814 17]

I have UHC as well through Wells Fargo. I did not have a 6 month requirement. I had surgery 2 months after my initial consult. Only requirement I had was a mental health evaluation and to use a bariatric center of excellence. It will all depend on your individual plan. Good luck. Sent from my iPhone using RNYTalk

Thanks ladies I will call uhc Monday. I don't mind waiting but Im just too excited!!!

[TurnThePage 220]

I wonder if there are different requirements for PPO vs. HMO? I have the HMO.

[desig1814 17]

I have a PPO and it's called choice plus

[mommashari 55]

I have UHC. They do require 6 months of supervised nutrition classes. BUT I got mine approved after 4 months. I had my lady doc and family doc sign off on me because we had discussed weight issues in prior appointments. Make sure you get the "doctor sign appointment" sheet and expense sheet from Optum. Message me if you want more details.

[stasea4 41]

All I had to do was psych evaluation 5 years of documentation of my weight an my labs ekg upper gi an I have UHC an my surgery date is November 19th yea!!!