Uhc insurance and bmi

[arenea 61]

I have uhc choice and my requirements are to be 40 bmi or 35 bmi with a CM. I was pre-approved due to my wt only. I'm on supervised month 4 of 6 and my wt has dropped below the 40bmi. Will this be a problem if it was documented at month 1 the required 40 bmi wt?

[Sleeve_Sistah85 193]

I have uhc choice and my requirements are to be 40 bmi or 35 bmi with a CM. I was pre-approved due to my wt only. I'm on supervised month 4 of 6 and my wt has dropped below the 40bmi. Will this be a problem if it was documented at month 1 the required 40 bmi wt?

I also have UHC Choice Plus and asked the same question to my Bariatric resource nurse. She said no, only the initial weight is what matters.

How did you get Pre-approved? They never discussed that with me.

[arenea 61]

Well when I initially contacted optum, they asked me a series of questions about my health and wt. I wasn't too sure about my wt and they told me I didn't qualify for the program. I called back later with my exact wt and they assigned me a case manager and sent me the forms for my Dr to fill out. That's what I mean about pre-approval because they wouldn't speak with me about wls in the beginning.

I hope I'll be okay. I have decreased the wt loss since my bmi is now 39.5... I don't want to risk the chances of being denied.

[arenea 61]

Hopefully I'll be sleeved by Jan:)

[Sleeve_Sistah85 193]

Yeah I have a tentative date of 1/11/16 and I'm hoping everything goes well with approval.

Perhaps you should cal your bariatric nurse they optum assigned to you and get your questions answered on record. Just in case ya know ????

[Champ715 207]

I had UHC and was required to stay at or above the 40 BMI during the 6 month process. On month two, my BMI was below 40 so I had to start my six months over. I contacted UHC just to clarify and they said that, yes, for my plan, my BMI had to stay above 40 during the 6 months. Maybe your plan is different but that's what I was told. Basically, if they see that you lose weight on the supervised diet, they think you can do it on your own and don't need surgery. If I were you, I'd call them just to be sure.

[arenea 61]

I called and they said they expect me to lose weight, and not to worry about falling below 40 bmi. That was a relief, but I do not plan to lose any more weight in these last 2 months. Just in case.

[Nora82 11]

They generally go off of you initial weight from your first appointment. They require the 6 month monitored and most insurance companies will deny you if you gain weight during your monitored so I would say even if you get denied (which is highly unlikely) you have a good case for an appeal.

[arenea 61]

What if your weight fluctuate, but never go past your starting weight. Is that okay?

[Nora82 11]

Fluctuation is generally ok and insurance companies take into account diet attempts when looking at your overall BMI. Just make sure your weight at the end of the 6 months is equal too or less than your starting weight. Some insurance companies will deny if you gain weight, justifying the denial by saying your not ready to be dedicated to trying.

[arenea 61]

Got it! Thanks a bunch:) Have you had your procedure yet?

[Nora82 11]

I have!!! Best thing that ever happened to me. I actually worked for my surgeon before 2 years before I was brave enough. Once I had it I wished I would've done it 2 years earlier.