UHC is driving me crazy!

[sassyfrass23 525]

Hi! I've mentioned this on a forum in the pre-op gastric sleeve group but am hoping for more information from this one.

So basically- I have UHC which covers bariatric surgery as long as I meet the requirements which is not a big deal or concern for me. However- I have learned that once my precert is submitted, I cannot schedule surgery any sooner than 6 months from that date. So if I submit and am approved in December, I cannot have surgery until May of 2016. I made sure each time I spoke with them that they are not referring to the 6 month diet/weight loss supervision. This is a year long process...apparently.

Has anyone else seen or heard of this? I keep praying that they are ALL confused and misunderstanding the information in front of them, but even reading it, it's pretty clear. I've researched all over the internet and have YET to come across a situation similar to mine.

I have to make my surgeon's office aware of this tomorrow as the benefits coordinator was completely unaware when I spoke with her previously about this and mentioned my concern. She didn't think it sounded correct and basically told me not to worry about it. But now I have no choice but to accept what is.

Just curious to know if anyone else is in the same disappointing situation as I. Perhaps I'm looking for a buddy to pitch a fit with

Or maybe someone to reassure me that this is not the end of the freakin' world and 6 more months is not really as bad as it currently sounds....

[BLERDgirl 6,417]

6 mths is not the end of the world. If that's what your insurance requires, you'll have to suck it up and go with it.

[mmincinci 17]

I have UHC and there was no waiting period like that. it doesn't make any sense. I would look hard into that .

My surgery was scheduled a few weeks after completion of pre-op tests.

[alainagirl 4]

I have uhc and they told me and the surgeon there is 6 months supervision. When I went to my consulationthe surgeon set my date rite after we meet and talked about the sleeve. My date is for 4-5-2016. So far it really is going fast.I though it would drag but I'm so worried about all the things I have to do that's what makes it go by quicker. I'm from central nj. Everything is going to b fine u will see it really does go by quicker than u think . Did

[chilepeppr4 29]

I believe I have the same 6 month time line as you, I'll find out more at my appointment on the 13th. I also have united health care community plan( I'm in NY)

[marleneb 6]

Hello,

I live in new jersey the requirements r 6 months new york also. I Google uhc requirements for baratric surgery and it gave me all the info I needed for new jersey. The told me and the surgeon the most important is the medically necessary letter from your primary, and phys. Evaluation then u have cardic , plumanary, gastrointestinal stomach scope, a few more then meet a the surgeons office 1 time a month this keeps ya quite busy ya wonder if ya make all this in 6 months some appointments ya have wait a month or so. I don't like the part were they submit it 2 weeks before my scheduled date oh well is what is!! Thank God there willing to pay for this very greatfull for that.

[snowflurry321 1]

I have UHC HMO and I have the 6 month diet and exercise monitoring requirement but no mention of a six month waiting period after that. A friend of mine with the same insurance went had surgery six months ago and once she submitted to her insurance it took about a week to get approved. She had surgery two weeks later. Hope this helps.

[sassyfrass23 525]

I have UHC *** and I have the 6 month diet and exercise monitoring requirement but no mention of a six month waiting period after that. A friend of mine with the same insurance went had surgery six months ago and once she submitted to her insurance it took about a week to get approved. She had surgery two weeks later. Hope this helps.

My doctors office doesn't think this is the case for me either. Unfortunately- a good bit of the reps who work for insurance companies don't exactly understand the policies so I have faith that they're misunderstanding my policy as well.

[karen091866 120]

I have United Healthcare (Optum / PPO plan through my husband's employer) ...and when I made my decision, the prerequisites were: 1) I had to register w/ a BRS Bariatric Resource Support through UHC Bariatrics...they assigned an RN to me, who followed me along the way, making sure that everything got done & nothing was overlooked. (the supervised dietician visits, the psychiatric eval, the labwork)...AND 2) the biggest prerequisitve was that the surgery location HAD TO BE a 'center of excellence'...a location that had a minimal track record of post-op complications, as did the surgeon.

THAT being said, I did have to change surgeons mid-stream ..I sure wish I had "Yelped" the place my primary care provider had initially referred me to...YIKES... Fast fwd--> I'm good to go for this Thursday, 11/19/15, with a wonderful surgeon. ---Just because the surgeon is a UHC provider doesn't mean that they meet all of the strict prerequisites UHC has for this type of procedure.

I can't encourage potential surgery candidates ENOUGh about the Yelp review bit...Never did I expect to read what I saw about the initial physician / location.

Once my dietician visits were complete, I scheduled my procedure the very next day...so if you haven't already, call UHC customer care and ask to speak to someone in bariatrics...NOT general surgery.

Best of luck to you..I'm sure it'll all smooth out...I've been covered by UHC for over 15 years and they're nothing short of wonderful.

[[[[[[ hugs ]]]]]]

Edited November 15, 2015 by karen091866

[chilepeppr4 29]

With United health care community plan, also my dr didn't mention it, do I need to stay at my weight, or can I hover around it? I'm confused

[marleneb 6]

Hello,

uhc has 6 months requirements after that u can have surgery. I'm going threw the process now . I believe customer care is mediare aarp threw uhc .I'm on uhc community plan also medicaid.

[marleneb 6]

I'm driving my self crazy! Enough of that just going to leave it alone. It will work out!!!

[chilepeppr4 29]

Hello,

uhc has 6 months requirements after that u can have surgery. I'm going threw the process now . I believe customer care is mediare aarp threw uhc .I'm on uhc community plan also medicaid.

Do you live in NY?? @@marleneb

[marleneb 6]

I live in new jersey!

[laurali520 4]

I have just been set back due to UHC coming in at last hour to tell me I need 6 months and pysch evaluation...however, I have made numerous calls and found the following as guidance. Currently working this way to re-schedule my surgery for Dec 10th. Good Luck..

write an appeal letter...must state that this is an URGENT BENEFITS EXCEPTION request...you will need to state your denial number, Member ID number, name, dob, etc...and then plead your case...list ailments, current meds, etc...and why you need this surgery. Fax # is 801-938-2100.