UHC is driving me crazy!

[snowflurry321 1]

My surgeon didn't even submit so I don't really have anything to appeal. It was just a requirement from my initial visit. But that's great it's working out for you. I've only got 60 days left so I figure I'll just wait it out. Took so long to even get the authorization for the consult so I don't want to rock the boat.

[Sleeve_Sistah85 193]

I have UHC choice plus. Yes there was 6 month diet program but NO additional 6 month wait after that. Sounds like the person you are speaking to doesn't know what they're talking about. Have you called the bariatric resource center for UHC? They would have the best answer.

[karen091866 120]

Cilepepp4...your weight along the way doesn't penalize you. You meet all of the criteria initially. That is what they go by for your surgery. If you lose weight during those 6 months, you still qualify. ....***btw, this is my 1st post-op posting! I'm in bed, barely 16 hours post- op--- my surgery went great. I was up walking last night & overall, pain has never gotten past a 5 on a 0-10 scale. Deep breath.. UHC will take care of you.
Post OP posting. Lol

Edited November 23, 2015 by karen091866

[sassyfrass23 525]

Well you just made me feel better, @@karen091866

I have been so worried about being denied because I dropped below my BMI of 40 for one month while on an appetite suppresent. I truly do hope that they go off of the information from my first visit which had me at a BMI of 41.

Congrats on your surgery! I hope your recovery is as quick and flawless as possible! We need to see pictures of the progress

Cilepepp4...your weight along the way doesn't penalize you. You meet all of the criteria initially. That is what they go by for your surgery. If you lose weight during those 6 months, you still qualify. ....***btw, this is my 1st post-ok posting! I'm in bed, barely 16 hours post- op--- my surgery went great. I was up walking last night & overall, pain has never gotten past a 5 on a 0-10 scale. Deep breath.. UHC will take care of you.

Post OP posting. Lol

[Nora82 11]

I work as a surgical coordinator and have never seen a 6 month waiting period after approval before you can schedule. I have noticed that it's hard to get any sort of correct answer when calling UHC. If your really worried about it I would call the pre authorization department and ask for a nurse case manager. They will give you the most correct information.

[sassyfrass23 525]

Ohhh...thank you, @@Nora82 ! You just made me feel 10x better. I've talked to them probably 10 times now and have yet to get a reliable answer. There's no way I could work with insurance on a daily basis.

With that being said- do you think it will be an issue if one of my "weigh in" appointments is coupled with a sick appointment? All documentation is there, but I ended up needing to be seen a couple of days prior to my monthly visit due to another issue I was having and didn't want to have to ask off from work again, so we went ahead and covered my weight issue while I was in there. I honestly don't think it will make a difference as long as all documentation is provided. I just know that insurance can be finicky at times.. :\

I work as a surgical coordinator and have never seen a 6 month waiting period after approval before you can schedule. I have noticed that it's hard to get any sort of correct answer when calling UHC. If your really worried about it I would call the pre authorization department and ask for a nurse case manager. They will give you the most correct information.

Edited November 24, 2015 by sassyfrass23

[Nora82 11]

Nope that won't be an issue at all. As long as your doctor puts in his note that you discussed weight loss.

[ld33 94]

@karen91866 what surgeon/ location did you use?

[samantha614 12]

I've never heard of doing everything, getting approved, and then waiting an additional 6 months (totaling a year) to have surgery. I'd double check that info. Good luck!

[Tosha-248 21]

What Criteria Must A Person Have Before United Healthcare Pays For The Bariatric Surgery

The criteria below will need to be met for coverage to be approved:

1. Class 3 Obesity or 40+BMI (Body Mass Index)

2. Class 2 Obesity of 35+BMI with any of the three following conditions:

   - Cardiovascular disease

   - Life-threatening cardiopulmonary or severe sleep apnea

   - Type 2 diabetes

MARYLAND REQUIREMENTS FOR COMPLETELY INSURED POLICIES

1. 40+ BMI without any health conditions

2. 35+BMI with the following conditions

   - Hypertension

   - Diabetes

   - sleep apnea

   - Cardiopulmonary condition

   - Life-threatening weight-induced medical condition

3. Proof that you have done diets but were not successful – Weight Watchers, Jenny Craig, etc. – for the last two years:

   - Participated in 1 organized diet platform for six successive months

   - Participated in 2 organized diet platforms for three successive months

4. At least 18 years of age or more

What Kind Of Weight Loss Surgeries Does United Healthcare Covers

• Biliopancreatic bypass

• Duodenal switch

• Gastric bypass

• Gastric Sleeve Procedure

• Lap Adjustable Gastric Bands

• Vertical banded gastroplasty

For adolescents

• Gastric bypass

• Gastric sleeve

• Lap gastric bands

Lap Gastric Band Fills: Are They Covered

United Healthcare does cover the lap gastric band fills for patients who undergo the Realize Band surgery or the Lap Band surgery.

What Weight Loss Procedures Does United HealthCare Not Cover

• Gastric electrical stimulation

• Mini-gastric bypass

• ROSE, StomaphyX, TOGA

Is a Second Surgery Allowed If The Lap Band Fails (Revisions)?

Assuming you have the same conditions from the first procedures, then yes a second surgery will be covered.

What If You Do Not Lose Weight?

If there are complications from the surgery, United Healthcare will cover all procedures and hospital stay.

Is A Center of Excellence Needed?

Nope. However, if you choose an in-network doctor, you can save yourself money – no out of pocket expenses.

Contact Information For United Healthcare

The contact information for United Healthcare varies by state.