United Healthcare?

[sassyfrass23 525]

Looking for anyone with UHC that has already been approved or are currently working towards approval from UHC? I'd like to pick your brain!

[Mania 128]

OK. Go

[sassyfrass23 525]

Ok!

1- How easy are they to work with? Are they super picky when it comes to approving bariatric surgery?

2- In my 6 month supervised diet/excercise, I have fluctuated in weight. One month I was put on adipex (appetite suppresor) and dropped 14 lbs in a months time. This put me below the BMI of 40 with no comorbidities. But the next month's weigh in, I was back up a few pounds which put me back at 40 BMI and taken off the med as it no longer worked on me. Will my BMI drop for that one month be an issue?

3- I've done monthly check/weigh ins with my PCP, and they've documented my weight each time, but idk what else if much more info has been documented about my efforts to lose. Does UHC look for detailed descriptions about my attempts?

4- will the fluctuating weight be an issue? I've managed to stay 5ish lbs below my original weight, but I can't seem to drop anymore and actually keep it off.

Edited October 27, 2015 by sassyfrass23

[Mania 128]

So my experience is very different but I will answer best I can.

1- I found them easy to work with. I was required to use Center Of Excellence (COE) through a Bariatric Resource Center (BRS). This provides me with a nurse who I talked to initially, but believe she will be more involved in following up after surgery. I also verified with my insurance beforehand what my palm covered and what was required on my end. All that being said, I was approved in under 2 weeks.

2,3,4 - I work for a large company so I don't know if that makes a difference in plans offered through the same insurer but I did not have a supervised diet requirement. I knew this before my initial visit with my surgeon. I have several co-morbidities (sleep apnea, type 2 diabetes, HBP, 3 previous back surgeries) that are well documented with my PCP.

That being said I would highly recommend 2 things:

1) Speak with the insurance specialist and/or the PA (or whoever Drs right hand person is) and ask them. They deal with this stuff all day every day and should be able to help you.

2) if you don't get a lot of responses, try opening up 2,3 & 4 to a larger audience, not just those that have UHC. Can't say it will be apples to apples, but might give you insight on what others had to go through

Hope this helps and good luck with everything.

Edited October 27, 2015 by Txbariatricguy

[lsmith715 55]

I was just approved last week and have United Healthcare.

I did the 6 month supervised diet but was far away enough away from the bmi limit not to have to worry about it. But honestly if you are below the bmi and have no comorbidity that might be an issue.

My Dr had.to fill out a form with my weights and what was discussed at each visit. I also had to provide the past 5 years of medical weigh ins.

I'm scheduled for 11/17 and can not wait. It was a long and hard wait.

Good luck!!!!!

[Champ715 207]

I started my journey with UHC and was told that I would be automatically denied if I dropped below the BMI of 40 at any point during my 6 month supervised diet. If they see that you got below that number on the supervised diet, they will use that as an excuse to say "well she lost weight so she doesn't need the surgery".

I was only barely over BMI 40 and did end up dropping below that number at my 2nd month weigh-in. The insurance coordinator called UHC and they said "yep, automatic denial. BMI must be at or above 40 during the entire 6 month process". I ended up changing jobs and getting a new insurance so it wasn't a huge deal.

They will probably deny you but you can always appeal and tell about the adipex. However, seeing as how you lost weight on a prescription appetite suppressant, they will probably say you don't need the surgery.

[sassyfrass23 525]

That's exciting news. I'm happy to hear that all has worked out for you!! And good luck with your procedure

I found out today that my policy states that after authorization is submitted, I have to schedule surgery 6 months FROM that date. I don't understand the additional 6 month wait. It's a bit discouraging. So much can change in a 6 month time frame, so it doesn't make much sense as to why they would require an additional waiting period once you've been cleared for surgery. Argh! I'm grateful to have it, but some times insurance drives me crazy!!!!!

I was just approved last week and have United Healthcare.
I did the 6 month supervised diet but was far away enough away from the bmi limit not to have to worry about it. But honestly if you are below the bmi and have no comorbidity that might be an issue.
My Dr had.to fill out a form with my weights and what was discussed at each visit. I also had to provide the past 5 years of medical weigh ins.
I'm scheduled for 11/17 and can not wait. It was a long and hard wait.
Good luck!!!!!

[sassyfrass23 525]

How far are along in the process? I wonder if the BMI during the 6 month supervision is based on your policy?

I called and spoke with the insurance company today and asked the rep if I dropped, and only for a month, would I be denied? I also asked if an appetite suppressor would weigh on their decision to deny or accept? She very strongly said no and that both are indicators of my attempt to lose weight on my own, but prove that I obviously cannot maintain the weight loss.

I've seen it go both ways...for multiple insurance companies. Everything is so convoluted. I understand it being a ton of money up front, but the cost they save in the end after surgery and the positive effects it has on your body/medical situation, you'd think they'd make the process a little easier.

Either way- I'll just have to wait and see how it all works out.

I wish you the best of luck in your process and hope it goes by as quickly and easily as possible!

I started my journey with UHC and was told that I would be automatically denied if I dropped below the BMI of 40 at any point during my 6 month supervised diet. If they see that you got below that number on the supervised diet, they will use that as an excuse to say "well she lost weight so she doesn't need the surgery".

I was only barely over BMI 40 and did end up dropping below that number at my 2nd month weigh-in. The insurance coordinator called UHC and they said "yep, automatic denial. BMI must be at or above 40 during the entire 6 month process". I ended up changing jobs and getting a new insurance so it wasn't a huge deal.

They will probably deny you but you can always appeal and tell about the adipex. However, seeing as how you lost weight on a prescription appetite suppressant, they will probably say you don't need the surgery.

[Dub 9,922]

I ultimately told UHC to go f@*& themselves and wound up self funding. They can kiss my large arse and the sting of the cost is subsiding with every pound I lose.

My experience, though, came from me following up on a number of health issues over the last year. Each surgeon/doctor I met with coached me to have bariatric surgery. I took their referrals and went straight into THE bariatric program.

Seemed a logical progression.

The problem is that THE program, while affiliated with the area's most prestigious hospital (out of 6 hospitals) wasn't yet certified as a "center of excellence" (bariatric certificate). They had a great staff, very supportive....and each were former bariatric patients, too.......excellent surgeon...etc, etc. They told me that it'd be no problem to continue and they'd had UHC patients go through all the time.

1/2 way through the deal UHC....who'd been supportive....all the sudden balks over the lacking "center of excellence" bullcrap. I involved the HR department of my employer......and found out that we were actually dropping UHC and moving over to BCBS. The games continued.

Our policy with UHC would have only covered me at 50% anyway.....and UHC was delaying. It was looking as if the surgery would be delayed to 2016....by then I'd be under new insurance and no telling how long I'd wait then.

Good news was for me, that when I did contact the center of excellence program they were fast in getting me started. They also had been at this for a while longer and had special self-funding insurance safeguards....you self fund and part of your money purchases a policy that covers ANY complication that comes from your bariatric surgery for out to 8 months. This was very appealing to me and I jumped all over it.

I'd already met most of my pre-op requirements for the surgeon and my patient advocate at the new center was extremely fast, aggressive and organized. She and I stayed in contact and had everything wrapped up swiftly.

The end result was that I had my surgery on October 13, 2015.......when it was looking like at best it would be late December or beyond. By self funding I was able to anchor down the timeframe and it actually cost me less than it would've to use my insurance. Wild ride.

The upshot of my story is this.....when working with UHC, or any of them for that matter.......stay in step with them upfront and avoid any bs later on. Involve your HR department at work if/when you are able to. It's amazing how much they can help.

Best wishes.