Insurance and Surgeons Office aren't on the same page!

[gina171 626]

So, I get on the phone with United Health Care Choice Plus for the third time today, the rep tells me what I see on my benefits page is what they see and what the Dr. Sees, but that is not the case! The insurance told me the same no diet length written in the policy but dr says 6 months! I'm just as frustrated!

Sent from my iPhone using the BariatricPal App

Jen, do you work for a really big company that might actually self-fund their own insurance plan themselves, and they just use UHC to be their plan administrators? I have UHC Choice Plus and that's my situation, but until I explained it to my surgeon's office that "I have a UHC card, and it LOOKS like I have UHC, but I really don't....they just do my company's paperwork" they didn't get it.

THEN they called and got the right answer.

Sent from my iPhone using the BariatricPal App

[Jenjen2016 32]

Well, I got on the phone again with them and they actually pointed me in the right direction to find the requirements on the UHC website under reimbursements and medical which makes no sense, but when you click in that and scroll to bariatric it's a 35 pages document just about the benefit. So, in all, since my dr's have not received any of my medical records yet, there is still the chance I may not have to wait 6 months.

Sent from my iPhone using the BariatricPal App

[kmorri 1,689]

Try a 3way call with insurance and surgeon's office.

[NewAngela 60]

I went to 2 surgeon but I decided to have my surgery with the third... Why? I had 10 months of supervised weight management with an endocrinologist, neither of the first two wanted to hear anything about that. The third surgeon was like if you have the weight management done, we'll fax over the paper to the doc and we can submit for approval.. I was like thank you, your the first doctor listening to me... In so many words he said the other two were just being greedy milking the insurance for office visits because they can... At that moment I knew why I loved this surgeon... He said lets get the paperwork rolling so you can get approved and get sleeved.. All this insurance nonsense is opening the door for greedy people to make extra money.. Some may say it's not all that much extra on one patient but if you think of all the patients they have it adds up... Really their not giving any medical care during the 6 month supervised diet, you don't need to be an MD to weight someone... The place I'm using is a center of excellence and it shows every step of the way... Good luck to you!

"We can't solve problems by using the same kind of thinking we used when we created them"

Einstein

The place I am going is also a center of excellence, and my approval was very straight forward.

Sent from my iPhone using the BariatricPal App

[Jenjen2016 32]

Me too center of excellence

Sent from my iPhone using the BariatricPal App

[hcamille 6]

My insurance said 6 months of documented weight loss but it didn't say supervised. I have myfitnesspal showing this but I'm confused by how they get the info if it doesn't need to be supervised.

Sent from my iPhone using the BariatricPal App

[betterme38 275]

Do they have a website where uou can print out the qualifications or requirements for the surgery?

☆Jeni☆

[hcamille 6]

Yeah, that's where I got the requirements I have bcbs of tn.

Sent from my iPhone using the BariatricPal App

[gina171 626]

Usually if they say documented it has to at least be confirmed by a third party....Weight Watchers meetings for instance, but Weight Watchers Online does not count since you enter your weight yourself.

Sent from my iPhone using the BariatricPal App

[gina171 626]

Do they have a website where uou can print out the qualifications or requirements for the surgery?

☆Jeni☆

Some insurance companies do not post printable docs online sadly; others WON'T email specifics on bariatric surgery, go figure.

I am someone who could get nothing firmly in writing. Fun!

Sent from my iPhone using the BariatricPal App

[hcamille 6]

Do they have a website where uou can print out the qualifications or requirements for the surgery?

☆Jeni☆

Some insurance companies do not post printable docs online sadly; others WON'T email specifics on bariatric surgery, go figure.

I am someone who could get nothing firmly in writing. Fun!

Sent from my iPhone using the BariatricPal App

That is awful, I guess I'm lucky I. That respect I've been obsessively researching insurance. Mine did say that they don't cover the other tests for the surgery, but I asked if I had my pcp put them in as routine and they said they would be covered so I guess that's something to discuss with the surgeon.

Sent from my iPhone using the BariatricPal App

[betterme38 275]

@@gina171, it's your right to know and have it in writing. You pay for the insurance you should know how it is/what it is so to speak. They have to give you something is what I'm saying not meaning it's your fault at all, just the stupid insurance should have mailed you a copy of your ins. They are Aholes sometimes. Can they mail you anytjing? May take longer but it will be in writing

☆Jeni☆

[mrz.mott 42]

So, I just was notified by UHC that they only Administrate the claims, that my employer sets the guidelines of the benefits. So I called them and asked if the providers office has called to verify my benefits, and they told me that they haven't talked to any providers. I'm getting so frustrated! What do I have to tell the surgeons office to get them do what I want them to do?

Sent from my SM-N920P using the BariatricPal App

[gina171 626]

Tell them UHC is NOT youR insurer, they are only the paid administrator for your company's plan.

The rules of your health plan are made by your company, NOT by UHC.

And your company's own plan does NOT have a specified wait.

So they need to call your company's plan administrator (UHC), and give your very specific policy number to get the right info, BC UHC rules are NOT your rules, BC UHC IS NOT YOUR TRUE INSURER.

UHC works for your company.

It's a whole different world.

And THAT'S why some people who carry a UHC card have no wait, and others with UHC have a 3-month wait, and still others have a 6-month wait.

The many flavors of UHC.

Sent from my iPhone using the BariatricPal App