United Healthcare approval?

[arenea 61]

Hello all, I am very new to the gastric sleeve process. I have united healthcare choice plan. I was able to search for surgeons on their website. My question is, do I make an appointment to see the surgeon directly or is a referral usually necessary? I am 5'5" 225 lbs and I'm afraid that I won't meet the qualifications.

[laguerr13 993]

You make the appt with anyone listed as "center of excellence" also shop around, there were two in my area, I chose the one recommended more by word of mouth, and listed in network, the surgeon can tell you if you will qualify right away depending on BMI and associated health like apnea, pain, etc....... UHC choice approves a high percentage as long as you do at least 3 dietician visits, also I was on a very tight budget and assumed everything was through my insurance, check to see what is included in the deal with the surgeon, you may need money upfront for certain tests, and the dietician, and things come up like Vitamins, and Protein, good luck let me know if you need anything, you can inbox me anytime I check once per day.....

[tamatha222 1]

You make the appt with anyone listed as "center of excellence" also shop around, there were two in my area, I chose the one recommended more by word of mouth, and listed in network, the surgeon can tell you if you will qualify right away depending on BMI and associated health like apnea, pain, etc....... UHC choice approves a high percentage as long as you do at least 3 dietician visits, also I was on a very tight budget and assumed everything was through my insurance, check to see what is included in the deal with the surgeon, you may need money upfront for certain tests, and the dietician, and things come up like Vitamins, and Protein, good luck let me know if you need anything, you can inbox me anytime I check once per day.....

Did you have a copay for the actual surgery? How long did it take for you to get approved? Thanks in advanced.

[arenea 61]

You make the appt with anyone listed as "center of excellence" also shop around, there were two in my area, I chose the one recommended more by word of mouth, and listed in network, the surgeon can tell you if you will qualify right away depending on BMI and associated health like apnea, pain, etc....... UHC choice approves a high percentage as long as you do at least 3 dietician visits, also I was on a very tight budget and assumed everything was through my insurance, check to see what is included in the deal with the surgeon, you may need money upfront for certain tests, and the dietician, and things come up like Vitamins, and Protein, good luck let me know if you need anything, you can inbox me anytime I check once per day.....

Thank you much, I will be contacting someone today.

[laguerr13 993]

My wife worked out the co pay with the surgeon and hospital , she put money down then we are making payments I think it only came out to $3500 for everything, not bad considering the hospital alone charged $68000.00

I got approved in less than a month because I met my dietician visit requirement quickly

[Chris-NYC 27]

I have United healthcare as well just be sure when calling from the list definitely make sure you feel comfortable With the surgeon office Personnel. I originally had one surgeon selected who was closer but every time I called they put me on hold then got disconnected a few times and then whatever call me back felt like I was bothering them. So I switch to a different surgeon who ended being fantastic.

I did have a few co-pays, of course this might vary based on your pacific plan.

$40 co-payments every time I went to the surgeon office.

$20 monthly co-pay to see my primary doctor for the six-month weight history review

$150 for the Psychologist

$250 hospital co-pay on the day I had surgery.

Now that I had surgery I spent approximately $25 give or take and Vitamins in mouth

Edited July 28, 2015 by Chris-NYC

[arenea 61]

Thanks Chris-NYC, that's great to know. I am meeting with the surgeon very soon. I am also meeting with my PCP soon as well. Do you know if I should meet with my pcp before the surgeon? And do I contact UHC and tell them that I am pursuing the surgery?

[taweedeegirl 68]

what kind of plan do u have? HMO/PPO?! and what state are u in?

everything varies

call the ins. company directly and speak to somebody there who is well-versed in the process

I would also contact my PCP before the surgeon if you have a HMO United healthcare plan you will need a referral to move forward with the nutrition ,psych, apnea

In regard to co pays my amount is 10 ..

It all depends on the an you have..

[Chris-NYC 27]

Thanks Chris-NYC, that's great to know. I am meeting with the surgeon very soon. I am also meeting with my PCP soon as well. Do you know if I should meet with my pcp before the surgeon? And do I contact UHC and tell them that I am pursuing the surgery?

Your welcome and I completely agree with taweedeegirl. I have did these exact same steps.

I would recommend you talking with ur PCP first about your decision depending on your weight medical history they probably will agree with it. If so ask for ur doctor for a recommendation letter to have for the surgeon.

I too would to call United healthcare on ur own before seeing a surgeon and tell them ur interested and bariatric program and wanted to learn more. ****Just do not automatically say that you want to have surgery*** lol. The person if knowledge should tell you the qualifications and direct you to the proper dept that handles this

United healthcare has select center of excellence locations that you must pick from. The last thing you want is to waste your time attending appointment at a non-covered office. It happen to me when I first thought about surgery. I went to a non-approved office even though the surgeon said not to worry United healthcare directly told me that if I continue to go to that center they will not cover my surgery. So I switch.

Edited July 28, 2015 by Chris-NYC

[mclorrie 219]

I have United Healthcare too. My PCP referred me to my surgeon, that way I knew that she was in-network.

[arenea 61]

Thanks you guys, this is very helpful