UHC issues

[cybergirl5710 22]

I started this journey back in September. I called UHC's bariatric resources back in September and registered for the program. I followed all the rules and started going to meetings at the Bariartics center I had to go to. I called back January and was told that that center wasn't the right one and that I was totally crazy. I couldn't have been told that.

I called my HR group and found out that the rules had changed I had to go to a different center--so I got all my paperwork together and went to the new place. If bariatric resources had told me that I would have been OK--but they told me I was crazy--I couldn't have been told that.

All of January I called them every day and left a message for my case workers. I called every UHC number I could find to figure who was really my case worked--I left message after message after message. Nothing.

I completed the 6-month dedically supervised diet, lost 5 percent of my wieght, got the psch exam, got the letter from my doctor---everything I was suppose to do.

Today, I get a letter from Bariatric Resource saying that I never registered for the program therefore I don't get approved at this time. I called the number on the letter, the lady tells me I have to start over and redo the six month medically supervised diet. They cancelled my enrollment in january because I don't "respond" to their phone call.

I'm so mad I say all sorts of mean and natsy things to the lady on the phone. I asked to speak to a supervisor--one is suppose to call me back--but based on previous experience--I doubt that they ever will. They have yet to EVER call me back.

So, now I have to file--in writing--a dispute.

I have no hope that I'll win an appeal. I'm sooo discouraged.

My work has been great so far--but they are waiting for me to get through this so I can start a project. They have actually postponed a project to wait for my to get through this--they can't do this for the months I'm sure it was take to dispute this.

Thanks for listening,

Feeling sad in Atlanta,

SAndy

[Sleeve Me Please 1]

Omg how frustrating! I am so sorry!

[Rebelgirl11 2]

Omg how frustrating!

Edited May 4, 2014 by Rebelgirl11

[Josh2xh 70]

Cybergirl,

I also have UHC and it literally sounds exactly like what I went through. I even wonder if you had the same bariatric resource lady I did? Was her name Felicia (but she pronounces it Feeleseeia)?

I started the approval process on September 20th 2013. I jumped through hoop after hoop finding out each time there was 1 thing I didn't do or was required to do. It was so discouraging. The biggest problem I found was completing the bariatric resource lady's stupid requirements. They basically cancel your enrollment if you missed something and you have to stay all over again. Unlike you I had no 3 or 6 month weight program requirement. The only requirements I had were from my surgeons office.

I first I got in, December or January, a call from this Felicia woman who identified herself as an RN with the stone group that sounded like a scam. The next thing she asked was for my suicidal security #. I had no idea who she was and it wasn't like she called right after I had done something bariatric"y". So I basically told her to piss off I wasn't giving her my SS#.

A month later I called UHC and they told me I was denied because I had not enrolled in the program. I had to talk to 3 different people before they transferred me to the bariatric dept (all 3 people were very friendly though).

Of course I got the VM of that Felicia woman and I realized what I had done. I cursed myself but I felt I did the right thing by not giving my SS to a total stranger. It took forever for Felicia to call me back and when she did it was so early in the morning I would miss the call. This went on for a week. Back and forth until we finally scheduled a meeting over the phone. Needless to say she was cold as ICE. She also refused to give me any information on how to get UHC to approve the surgery. This was all back in February. My favorite part of our conversations was when she would tell me that if I didn't get approved within 30 days she had to drop me from the program.

End of Feb I submitted a dispute to my earlier denial. I called after 5 days and they told me the process could take up to 8 weeks. I was heart broken. I really didn't want to deal with this woman anymore.

After checking back constantly I found some nice lady at the UHC dept that said "I really can't give our this information but in the past I have seen the dispute claims denied. But a NEW approval submission like in your case get approved"

I just about pooped my pants with happiness. I called my surgeons office (they had been great throughout the whole process) and gave them the news. They expedited the new request and within 14 days I had my approval.

Once I was approved calls started flooding in from UHC. Everyone I spoke with was wonderful and helpful. I still can't believe how much support they provide. I haven't received a bill as of yet. So I am on pins and needles. But I have to say once approved I really felt like UHC had my best interests at heart.

So basically this bariatric woman is the Guardian at the gate. If you can get past her it's smooth sailing on it. It's also possible she is just a mean spirited woman and anyone else would have been helpful.

So my thought would be to have your surgeon submit an entirely new claim. See how that goes.

[Josh2xh 70]

Oh, I forgot to mention that my first denial in November was because the facility requested was not a COE (center of excellence). Turned out my surgeon actually had privileges at the COE in Irvine California, so I didn't have to change surgeons.

Make sure you're requested surgery center is a COE.

[cybergirl5710 22]

Thanks Josh@xh,

That was great information.

I also started this journey in 9/23/2013. Between September 2013 and January 2014 I participated at Piedmont (Bariartric Resources gave me the name of the center) In January 2014, Piedmont was dropped from the list and I had to start at Emory. I've participated there since Janauary and I think I've meet all the requirements--but who knows what they'll change tomorrow

So far, I've talked to Keesha--very nice--my first case worker and Diana.

[Hoginona04 61]

I started this journey back in November. Paperwork was subimitted to UHC on May 1st and I received approval yesterday May 12th. My case worker at the Bariatric Center has been awesome, and helped me out every step of the way.

[Krystal0528 118]

I also have uhc, but my process has been nothing like what you all have been thru. My case workers name was kelly and she was very persistent; calling me once every 2 weeks, sent me packages I'm mail with xtra info. My surgeons office sent submitted everything for an approval on 4/1, an my case worker kelly called me on 4/3 with GREAT news;) I was initially scheduled for 5/7 but i had to reschedule to 5/28 so I could be of for wrk.

[cybergirl5710 22]

Just wanted to let you know that I've been approved! I was approved June 2th. I'm going a nutrition class today and will hopefully get my surgery scheduled in the next week. In my program--just before surgery--you have to attend a nutrition class that goes over the pre- and post-surgery diet. . .and pay them $600. This class is in addition to the 6-moths supervised diet.

After my last post, it took about 2 weeks to get my approval letter and the name of a bariatric's nurse--she was really great by the way. I didn't wait for her to call me--I started calling her right away. She returned my calls the next day every time--I wasn't like the experience in early January. (By the way, in my case, a group called OPTUM, manages the bariatric cases for United Health Care--so if you get a message from OPTUM--answer it--it's probably your bariatrics case worker)

I kept my phone with me at all times and thought of an excuse to call the nurse every couple of days. I was so afraid that they would come up with some other reason to reject the claim--but they didn't.

Thanks for your support and if you're waiting for approval--I hope you have success also!

[Pelicanlady 122]

Congrats. Sure was a long time coming for you. You are one strong, determined lady. Hope you get your surgery date very soon. You've done enough waiting.

I have UHC CHoice Plus and my experiences was nothing like yours. I think I would have gone crazy if that happened to me. I started my journey on April 28, 2014, paperwork sent to insurance May 28th and approved June 4. I am having my surgery July 8th.