MIMISAN 404 Posted June 26, 2015 To me this is strange but with my insurance which is UMR (United Healthcare Choice Plus) they do things oddly. First of all I had to talk to an insurance person that asked me questions and verified that I qualified for the surgery that I am requesting. Then they assign me a Nurse Case Manager. She called me for a telephone appointment and we talked about a variety of things like, what made me want the surgery, what I expected as a result etc, then she explained things that have to be completed before my paperwork is all completed and submitted to my insurance for final approval to go ahead with surgery. 1. I have to have surgery in a hospital with Center of Excellence approval 2. I have to have 6 months consecutive supervised dieting 3. Have to complete a psych evaluation 4. Have to have a Consult with a dietitian. 5. In my case I need to have a visit with my cardiologist to approve because I have supraventricular tachycardia. The funny thing is that I asked her what the insurance expected of the 6 months dieting. Another words did they expect a certain amount lost per month etc. and she said that it didn't matter whether I gained or lost I just have to show that I was trying????? Isn't that odd? Then I asked her about the possible problem of starting this journey in July with the possibility that my company insurance plan might change in January and if they cut out bariatric surgery after that six month wait I would be devastated. She was surprised and said she had never had anyone ask that question and I thank the board for that. What she suggested I do was get into my Dr. before the first so I would have an accepted June date stamped and then I would add, July, August, Sept, Oct, Nov, and should be able to get the surgery in late Nov or December. I thought it was great of her to try to help me figure this out. She also brought up some information about my thyroid medication that I will be discussing with my Dr. on Tuesday the 30th to get my 1st month stamp! All in all I really liked the woman and I hope it all works out and I get to talk to her more often, she made me feel good about my decision and about the insurance company. Share this post Link to post Share on other sites
amsleeved 13 Posted June 26, 2015 Very similar to what I had to do. It was great, though. Met with the dietician 3x, social worker, cardiologist, and surgeon and frlt a lot better Share this post Link to post Share on other sites
amsleeved 13 Posted June 26, 2015 About the surgery. Case manager has been in touch a few times and was very supportive, and insurance has a free membership to participating gyms that I use. Share this post Link to post Share on other sites
AJ cowgirl 79 Posted July 3, 2015 (edited) I am a fellow sleever (6-16-15) and a Medical Social Worker. I understand the insurance made you feel odd, but be happy they are caring enough for you to make the requirements that they did. I have worked with a few patients years after surgery that perhaps did a WLS for expectations that were not fixed with surgery. Such as new job, abusive partner, substance abuse, and other issues that really where not going to be changed without very hard work. Many of the insurance companies want successful outcomes for you and make very tough standards because of the rates of psycho-social issues of failed WLS folks whom maybe had the wrong expectations. Edited July 3, 2015 by AJ cowgirl Share this post Link to post Share on other sites
