UHC Choice Plus - HSA (MO) - Perplexed - no requirements?

[no onions 258]

Hi everyone, long time lurker, first-time poster. Any thoughts or comments to my topic are certainly welcome.

On the advice of my gastroenterologist and primary care physician, I began to explore WLS surgery in the summer of 2014. My 2014 insurance coverage specifically excluded WLS surgeries, etc. To prepare for the possibility of WLS surgery, I switched to a new plan offered by my employer that does cover WLS surgery.

I called UHC today to find out details about the requirements for WLS surgery. What I was told:

• WLS surgery is covered if recognized by the NIH as effective for treating long-term morbid obesity.
• Specific surgeries mentioned by the rep (verbatim), but not limited to: gastric bypass, gastric banding, roux-en-y and vertical banded gastroplasty.
• No requirements - no 6 month supervised diet, in fact, nothing mentioned about BMIs or comorbidities.
• It is not possible to get this in writing (apparently) and the documenation is unpublished to the insured individual on the MYUHC website.

I have followed the boards long enough to know that insurance can be a big stumbling block for some. I am not at all convinced that I was given accurate information. I quizzed the rep several times and made certain to document the conversation (names, dates, reference numbers, etc). I guess I will know more once a surgeon actually sends off for pre-certification, but I just find the lack of requirements so odd.

Edited January 2, 2015 by no onions

[wannaBthinsoon 1,634]

wow. I called UHC and was given the BMI requirements, and co-morbidity requirements if BMI is less than 40. I'm in Kansas. You might want to call back and speak with someone else and get a name, and write the name down for sure! Sounds like you might have gotten a trainee.

[onmywaytobeingfound 163]

I have uhc in Ohio through my husband's employer. I had surgery 12/30/14. I did the weight loss program through Ohio Health. Uhc immediately sent approval to Ohio health. All I had to do was complete my programs requirements, which was do a minimum of 3 dietician appts, sleep studies, specialists visits etc. I entered the program in August 2014. I did lose 25 lbs following dietician instruction post op. But was not required to by insurance or Ohio health. But once you enter a program they should send off all paperwork to uhc and then you and your program will get a paper of coverage. It was that easy with mine. But from what I hear my uhc is abnormal compared to other insurance companies. Good luck!!

[no onions 258]

Thank you for the replies.

WannaB - I'm planning to do that (call back in to see if I get a different answer). :-)

onmyway - the rep said something similar to me about my employer's plan (she's never seen one quite like it).

I'm also planning to follow-up with the WLS program I'm interested in next week and may just allow them to submit on my behalf and see what happens.

Good luck to you both as well.

[Walter Lindstrom 42]

<<It is not possible to get this in writing (apparently) and the documenation is unpublished to the insured individual on the MYUHC website.>>

WRONG - It is possible but geez . . . why would an insurance company want to make things easy for their members, right? The UHC medical policies (Hint: like MANY other insurance companies) have their medical policies buried in the "provider" section of their website(s), not the member portion. Here is a link which should (if I did it right) get you to a pdf with UHC's complete medical policy:

http://bit.ly/1vIO2Ht (If I didn't do this right feel free to email me directly)

Hope that helps!

[no onions 258]

@@Walter Lindstrom Jr. - thanks so much for the reply. That is really very helpful/informative!