United Health Care Predetermination?

[allykat 1]

Hi all,

I called UHC last week to find out if the surgery was covered by my policy. It is...$200 deductible at 90% - great news! I was also told it is subject to predetermination paperwork? What is that exactly and what all does that involve? Is the process long with UHC?

I know I called the doctor I've chosen and was told that after attending the seminar next week, I'd make an appt. with the surgeon and then be referred to a nutritionist and the psych eval. The psych eval, I was told, takes the longest as it can take about 2 weeks to get in and then another 4 weeks after for the eval to come in. Just wondering if this is all the stuff UHC needs to approve?

[juliegeraci 7]

I'm not sure if it was a requirement of UHC or

[juliegeraci 7]

I'm not sure if it was a requirement of UHC or not but I had to do the psych eval, nutritionist and bloodwork. I think they have a predispostion BMI rating for surgery. You may want to find that out.

[destiny79 0]

this was my uhc Predetermination:

BMI over 40 auto. approval

BMI of 35-39 you need 5 years of weight history showing how long you have been a bmi of 35-39

2 co- morbities

no psych eval, nutritionist nothing else

mines was approved in 7 days with only a BMI of 43 I did labwork after I was approved so I think that was for the Dr. purpose

[allykat 1]

Thanks all! I was wondering if the nutritionist visit and psych evals were always required. I know my BMI is over 40 and I'd love to skip some of the delays and just do it already. I was told by the receptionist that the psych eval and report is what takes the longest, usually up to a month or better. I go for the seminar tonight and can then make an appt. with the surgeon, where I guess I'll find out for sure.

[destiny79 0]

that's great well it looks like you will be one of the newest banders

let us know when you get approved .... sending good vibes :tongue:lol

[stacy73 2]

My approval was based on bmi of 40 and 5 yr weight history-the other criteria is set by the surgeon and it is mainly to satisfy the requirements of having surgery in a bariatric center of excellence-you can ask your surgeon to send his letter before all the requirements are completed, but most want to do the psych eval, intitial lab work first then submit to insurance.

[Chris61 0]

If you forward me your email address I will forward you a letter that my wife and I used for getting approval with UHC. We were approved within 30 days after the stuff was sent in. We got all are records together from all are doctors. It took a while to do that put it did work. We had problems with one doctor but went to her OBGYN and got the stuff and was approved.

Chris

[Amy1977 0]

My doctor submitted my BMI of 43 to the insurance company and within 10 days I was approved. I didn't have to do any psych evals or nutritionist visits. I don't have any health issues (diabetes, high blood pressure, etc.). I wanted surgery to get health to prevent future health issues. I was approved right away. I never consulted my PCP. She didn't know I had done it until 6 months later when I went in for strep throat. I have had a very good experience with UHC.

[vonnie230 0]

Hello ALL! I'm a state of GA employee, and Ive been researching the band. O found this site through a search on goggle. However, when I log into the site, I cant find this thread. I go to main lap band surgery, insurance, then cant find this blog and there is a million blogs on this site, so Please tips on how to get to this blog:blink:

[allykat 1]

Hello ALL! I'm a state of GA employee, and Ive been researching the band. O found this site through a search on goggle. However, when I log into the site, I cant find this thread. I go to main lap band surgery, insurance, then cant find this blog and there is a million blogs on this site, so Please tips on how to get to this blog:blink:

Vonnie,

It is probably because this is a pretty old thread. I will tell you I am also a state of GA employee and unfortunately, all state policies have exclusions to weight-loss surgery. I wasn't told that when I initially started calling with the procedure codes, but in my journey, it became clear I'd have to be self-pay.

[sahmof3 0]

The requirements may come down to the doctors office also. I had to have the first seminar, nut seminar, pysch evaluation down before they would submit to UHC Choice Plus. Mine required a BMI 40+, 5 yr weight history, and a letter from my PCP. I was approved in 4 days.

Call them and ask what they need. All are different.

Good luck!

[vonnie230 0]

Are you a State of GA employee?

[sahmof3 0]

Are you a State of GA employee?

No. I am in VA and the insurance is with my dh's job.

[sherry62 0]

you have UHC and approved in 4 days?