United Healthcare Choice Plus (Medica Self-Insured)

[abbyabby 11]

Need your opinions please. I can't get a straight answer about the 6 month diet. My docs office says it's a requirement for my insurance (even though they haven't filed for prior auth yet). My husbands HR department said it's not one of their requirements. I've called UHC myself several times. Been told it's not needed. The last time I called I was told it's not on my personal policy, just a general requirement of UHC. The lady on the phone didn't know if I needed to complete it or not. What do you think? I'm confused.

[mommashari 55]

Need your opinions please. I can't get a straight answer about the 6 month diet. My docs office says it's a requirement for my insurance (even though they haven't filed for prior auth yet). My husbands HR department said it's not one of their requirements. I've called UHC myself several times. Been told it's not needed. The last time I called I was told it's not on my personal policy, just a general requirement of UHC. The lady on the phone didn't know if I needed to complete it or not. What do you think? I'm confused.

I have UHC and it was a 6 month requirement BUT my did only take 4 months because I had previous documentation from doctors.

[TurnThePage 220]

Here's a link to UHC's Statement of Medical Policy. Near the bottom of page 3, one of the bullet points stipulates the six month program. There seems to be some gray area and that may vary depending on whether you have an HMO or PPO or other type of policy, and may also vary by state. You need to get the answer in writing from the insurer in order to be certain.

My surgeon's office was not told of this requirement they phoned to verify my HMO coverage at the start of my program. Months down the line (delay due to death in the family), I completed the surgeon's program and my file was submitted for insurance approval. It was denied due to lack of the 6 month program. I appealed and did win approval--but only because I had completed the insurance company's own diet program 6 years earlier. [Ok, so me mentioning I had consulted with an attorney specializing in bariatrics and citing my comorbidities may have helped.] So for my HMO it was a requirement, but when I brought it up on a forum, some UHC PPO insured said they did not have that requirement.

I strongly recommend you get a letter from the insurance company that clearly states your requirements--and whether or not you are required to fulfill the 6 month diet program as stated in their Statement of Medical Policy.

[TurnThePage 220]

Oops! Sorry! Forgot to put in the link to UHC's Statement of Medical Policy.

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf