Just Waiting

[acuttita 49]

So I had my first visit with the surgeon on March 12th and I loved him. We discussed the procedure and everything that happens afterwards. My only thing is that since I am going through my insurance, United Healthcare, I have to do six months of nutrition appointments. Real bummer!! What I don’t understand is that this is a requirement of UHC but I come to find out that they don’t pay for the nutrition visits. How can they make this a requirement of the surgery and refuse to pay for it? If that’s the case, then either pay for it or allow me to do the one visit like my surgeon recommended and schedule the surgery for when I want. Well being that they don’t pay for it, I’ve decided to appeal this policy with them. I have no issue doing the visits but then pay for it. Right now I’m just waiting for their decision. Has anyone ever tried this? If so, what happened? I figured I have a 50/50 shot and the worst they can say is no so why not at least try.

[aNYCdb 310]

Honestly I have never heard of an insurer not paying for group nutrition classes (this seems like the cheapest thing an insurance company could ever pay for). What was the reason for the denial? Is it just not covered by the policy or was there a secondary reason (for example it needing to be refered by your PCP?). That said I believe that most insurance companies also will accept letters from a doctor (one for each visit), so perhaps you could swing a way for you to visit your primary monthly, for something (or presumably if you are close to them they will sign the form with just a weigh in and bp check).

[JacquelineC 43]

All the Insurance’s are different. I am on Medicare . They cover, but you have to do 6 monthly visits to your general practioner, see phycologist once, see nutritionist,

go to support groups.

Then my doc had a program fee besides, which included his nutritionist, the 10 days of food packages before the surgery , the Vitamins, the B12 also. This is a very involved process ! I am 1 week out and it is a challenge! My problem is that I bought the two weeks post op packages from docs office , I cannot stomach them because sweet stuff makes me gag!

So really look into everything carefully. Good luck!

[Danny Paul 761]

As an end around If you are diagnosed with diabetes the insurance company should cover the nutritionist visits.

[acuttita 49]

So I received this letter today from the insurance company in regards to my appeal. If i am reading it correctly, they are waiving the 6 month nutrition visits prior to having the surgery. Is that what everyone else sees or understands?

I called the doctors office and forwarded them the letter and she said she’s never had anyone appeal the six months with UHC but will look it over since their rules state six month visits.

Should i hold my breath and not get my hopes up?

[abefroman329 704]

Yes, it looks like your insurance company is no longer requiring six months of nutritionist visits.

No, that does not mean your doctor's office won't require you to go to the nutritionist for six months regardless.

The only requirements I ever saw were the surgeon's. The surgeon's office told me that BCBS' requirements were "about the same" as theirs. If there was anything the surgeon required that BCBS didn't, I was never made aware of that.

[TGTCEGCC 2]

That’s amazing that they simply waived it. I would love to know what your appeal letter said! [emoji1317]

[acuttita 49]

That’s amazing that they simply waived it. I would love to know what your appeal letter said! [emoji1317]

I can’t believe they waived it either. My appeal letter basically just asked them to pay for the six months nutrition visits and in turn they decided to waive it. I guess that was a better option for me. I’m hoping next week I can get my date [emoji1374]

[acuttita 49]

Yes, it looks like your insurance company is no longer requiring six months of nutritionist visits.
No, that does not mean your doctor's office won't require you to go to the nutritionist for six months regardless.
The only requirements I ever saw were the surgeon's. The surgeon's office told me that BCBS' requirements were "about the same" as theirs. If there was anything the surgeon required that BCBS didn't, I was never made aware of that.

Yes my doctor still has me doing one nutrition visit and a psych evaluation which I am content with. My appointment for nutrition is next Thursday so I’m hoping i get my date thence

[TGTCEGCC 2]

Good for you! Glad you got your process sped up also! [emoji1317]let ya know how everything goes. [emoji173]️

[Losebig 508]

Get in before they change their mind! That's great news that they waived it. I switched to UHC just after surgery and my UHC policy explicitly says it does not cover WLS.