United Health Care Insurance

[Sleeve1stFitNext 924]

I am writing this to help those whom have United Health Care. Here are the following things to know and tips:

Before reading these tips, contact UHC for confirmation that Bariatric surgery is covered under your plan. Confirm the requirements. Confirm that your surgeon and his associated hospital is In-Network (if they are not, it will be like paying for the surgery without insurance). Make sure you have an understanding of what the insurance wants to see or have done.

1) You are eligible if you have a 40 BMI or Higher / Greater than 35 BMI with Co-Morbidity.

2) Once you find your surgeon, you will have to do 6 months worth of testing, dieting and education.

3) You will have to make 6 visits (once a month). This does not include your consultation.

4) One of your visits will be with a Psychological Evaluation. This will determine your surgeons view and the insurance company's view of your case. They take a look at your mental and emotional health. They ask about your family and your support systems. They may ask you how you feel about yourself. Stay away from the negative views you may have of your body. Understand that they have seen hundreds of people like you and may have some prejudice in regards to whether you will succeed or not. Remind them that you are a person, not a statistic and bring some human to your discussion.

5) Your surgeon may require you to keep an eating and exercise journal. I use MyFitnessPal and I have a FitBit.

6) You will be asked to do an EKG to see how strong your heart is.

7) You may be asked to do a sleep study. Depending on your surgeon, it can be a requirement. In my case, the insurance company denied it. They did not deem it as a necessity.

8) You will have to do an Ultrasound which is to see if you have any issues with your liver (fatty liver disease) or other organs.

9) The next thing is an endoscopy. This requires you to head to an outpatient clinic, be sedated and have a tube stuck down your throat. (Update: You will need to have lab work done no more than 1 month prior). I learned that I had an hiatal hernia (where part of the stomach enters the diaphragm). This can cause you heart burn. Be aware of H. Pylori. This is a bacteria that can cause ulcers and heart burn as well. It takes a lot of antibiotics to cure. Be mindful that your throats will be sore and some sharp pains may occur as they most likely scrapped some samples from your digestive tract.

10) In between these visits, you will see an dietitian and nutritionist for further help. They will slowly walk you through changing your eating habits. Be honest with them. It is very important in the long run. Also try to keep your weight lost in small amounts. If you lose too much in a short period of time, the surgeon and insurance company will feel like you can lose the remaining weight alone.

11) Your last visit will consist of an overview. The surgeon will check your weight and may discuss further with you about your feelings towards the surgery. Hopefully you are approved by the surgeon. My surgeon was great during the process. I met with him more times than anyone else. He literally kept giving my information and sites to read to understand this tool.

12) They will then submit your information to the insurance company. Now it can take up to 2 - 6 weeks for approval. I was approved in one week.

My fellow UHC Members, I hope this assist you in your endeavors. 6 months will fly by so quickly you won't even realize it.

Remember education is the key to success.

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[Sugarnspice 150]

I have UHC also but was into required a chest X-ray, EKG & lab work for pre-op testing everything else was the same.


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[Sleeve1stFitNext 924]

My chest X-Ray was required after approval for surgery.


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[JessNewGoals25 23]

Omg thank you so much for this break down. I really wanted insight on things with this insurance so I greatly appreciate you for sharing this info

[KGee88 8]

I spoke with UHC and there was no mention of 6 months of testing, dieting and education. I'm currently in a bariatric program through my local hospital that has 3 months of all that- then after 90 days I'll submit all my paperwork to the insurance for final approval. But I meet with my surgeon on Monday so maybe I'll get information. I'm not opposed to continual waiting but I hope it's not an additional 6 months to the 3 I'm currently working through. Might I ask what state you're in?


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[darstvader 31]

Mine with UHC was a continuous 6 month program, had to be in network, BMI of at least 35, documented min 5 years of obesity, at least 18, chest X-ray, one bariatric surgery per lifetime. My plan is in Florida but it's also self insured, so my employer gets a lot more say in what's covered and what's not and what the stipulations are.


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[Sleeve1stFitNext 924]

13 hours ago, KGee88 said:

I spoke with UHC and there was no mention of 6 months of testing, dieting and education. I'm currently in a bariatric program through my local hospital that has 3 months of all that- then after 90 days I'll submit all my paperwork to the insurance for final approval. But I meet with my surgeon on Monday so maybe I'll get information. I'm not opposed to continual waiting but I hope it's not an additional 6 months to the 3 I'm currently working through. Might I ask what state you're in?


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I am in New York City. Due to each state having their own requirements as well as employers, that is why I put to contact UHC to learn the plan requirements. Most people whom I have met, had the same requirements as me. I have learned that some people get less time and do require all the things I listed. It's great to know the different plans and how they work.

[JessNewGoals25 23]

I wish 3 months was the case here? I'm in Wisconsin. But at the same time I'm still preparing mentally for what's to come & trying to break some bad habits so it's not as hard for me once I have the surgery.

[Sleeve1stFitNext 924]

I agree. I have been using the 6 months plus the wait time til surgery to change my habits. I have been practicing the eating slowly and drinking slowly. I have also been practicing the drinking 30 minutes before and then 30 minutes after. It is very hard to remember this habits.

[JessNewGoals25 23]

Yes my hardest is the chewing slow ESPECIALLY when I'm hungry... I completely forget then feel guilty afterwards. & im trying to cut down on my sweets & high carb intake...it's definitely a process but a really good long term lifestyle change

[KGee88 8]

Interesting. I'm also in New York (Upstate) but my bariatric coordinator has been a great help. I meet with the surgeon on Monday. Now I feel like I should call the insurance back but I've read the policy they have me.


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[Sleeve1stFitNext 924]

Agree.

I was able to cut down on the sweets but not completely. Carbs are the hardest to cut back on because everything has some carbs in them. My surgeon says that once I have the surgery, my body may react differently to sweets in which will make me sick, he said once you get sick, you will not want to eat certain sweets every again.

[JessNewGoals25 23]

Good for you with the cut backs so far. & wow that's crazy. & my friend successfully did the gastric bypass about 7months ago & she just had her check up on Thursday & her dr told her that she wasn't getting enough carbs or eating enough. She was scared. She said once she felt her appetite coming back she was scared which I understand & the support group that I went too said that it's normal BUT that it's important ur eating what's required or you can hurt yourself that way too.

[Sleeve1stFitNext 924]

I think that I would be scared to eat as well. Some of the people in my support group whom have lost a lot of weight say that they are scared to eat. They say it is like food was once their friend and now its a bitter enemy. They said they had to learn a healthier way to look at food again.

[NWJill 119]

I have UHC in Washington state and this is similar to what I had to do, good summary


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