United Healthcare - Just Beginning

[amy.taylor8414 6]

Hi! I am really excited to start this journey and I was really happy to stumble across this website. I recently attended a weight loss surgery seminar, and I am really excited to get started. I (like a LOT of people) am extremely worried that I won't get approved through my insurance. Does anyone have experience with United Healthcare? Are they pretty easy to get approved through? My plan says I need complete a supervised diet and exercise program through the surgery team, but it doesn't say for how long. I'm trying to get this done this year, since my husband and I have met our out of pocket max, and everything will be covered at 100% now. Surgery included (I checked). I am worried that if I have to do the 6 month diet, I won't get a surgery date in time for it to be covered at 100%. Advice, suggestions, experience, strength, and hope?

[jeanniereenie 177]

i have united and i had to follow a 6 month plan, but the day i finished my last counseling session i got approved THAT day...so good luck!

sending happy thoughts your way!

[Swampdoggie 477]

@@amy.taylor8414 I'm a ditto to @@jeanniereenie

[BrownEyedTxGirl 139]

I have United Healthcare as well but everyone's requirements are different based on what benefits your employer selected. Mine requires 6 months of supervised nutrition and 5 years doctor documented history of a BMI over 40. I don't have time for all of that so I am just going to pay cash!

I would call UHC and have them outline all requirements and exactly what costs they cover. Took me only about 15 minutes to get all of this info from them over the phone.

[lorralei 21]

I also have United Healthcare - As BrownEyedTxGirl indicated, every plan is different. My employer has 2 paths - BMI >40 - go for it, and BMI >= 35 +2 Co-Morbidities. We are also required to enroll in the Bariatric Resource Center (BRC.)

I lucked out - no supervised diet, no 5 yr weight history, no psych eval... Although, my doctor requires the psych eval and recently adopted protocol that required EGD. Certification lady at office recommended that we wait until I am approved before having the EGD.

My paperwork was submitted on Tuesday (6/24/15) - BRC nurse indicated in surgeon provided all the supporting documents when submitting the pre-cert request it should take no longer than 15 days. If missing paperwork, it could take 45 days. Crossing my fingers they got it all submitted... the Certification lady at the office is not the most organized. Being a little OCD, it's driving me batty.

I've met my maximum out-of-pocket, and with work obligations, really need this done no later than late September.

I'll update when I get my next relevant piece of information.

[amy.taylor8414 6]

That sounds EXACTLY like what I was told too. Although I do have the psych eval and 2 year weight history. I have met my out of pocket too and I am trying for August. Keep me updated on how long the approval takes? Thanks!

[wannaBthinsoon 1,634]

Same here as @@lorralei . It was easy peasy. UHC has recently dropped a lot of the requirements other than BMI now. You had to have discussed weight loss with your PCP, but not for any specific time. And the psych eval was for the Bariatric center of excellence, not for insurance.

[WontonAnimalChIndo 18]

I have UHC as well. I had my 6 month doctor supervised weight loss, 5 year weight history, and psych eval. I was approved with no problems.

[agalindo17 331]

I have UHC too but all I need it was the 6 month supervise diet and psych evaluation blood work and be clear for surgery and I was approved in a week after it was all submitted also cover 100% only had to pay $250 for a over night stay at the hospital but had my own room so I was ok with that! Good luck!!

[beba238 123]

My husband has uhc. He was told that he needed to have uhc for at least 5 years in order to have the surgery. I think this is ridiculous.

[wannaBthinsoon 1,634]

@@beba238 OH WOW! I took out my UHC insurance January 1 and was approved for surgery in February. Had my surgery in April. 5 YEARS!?? holy cow!

[00612 12]

I have UHC also, and was approved on the same day that my paperwork was submitted. All I needed was 3 months of nutrition visits, psych evaluation, EGD, and blood work.

[Sharon1964 2,530]

My husband has uhc. He was told that he needed to have uhc for at least 5 years in order to have the surgery. I think this is ridiculous.

I would check again, that definitely doesn't sound right. What that amounts to is a 5-year pre-existing condition waiting period, which is not legal in any circumstance that I can think of.

[beba238 123]

I'm definitely going to have him check it out. He was on the phone with them to get reimbursement for something and he happened to mention the surgery and that's when they told him about the 5 year minimum. He told that to the doctor and the insurance lady and they said that wasn't true but then a month later they called him and cancelled all his appointments because the insurance lady spoke to uhc and they said it was truly and that he needed to wait another 2 years. He went to another hospital. And they said that was bull but then the insurance ppl called him back and said in fact that it was true. He had done his 6months and everything. He was devastated. I will have him call another hospital and not mention the 5 years just in case. Hopefully he gets approved.

[Sharon1964 2,530]

I don't think calling a hospital is going to help you. Call United and get your benefits booklet, if you don't already have it, and ask them specifically for their bariatric surgery policy in writing.

Is this a group plan through employment or an individual plan?