UHC....approved!

[AngelaW 0]

Hi everyone. I have been lurking around on this website for a while but have never posted. I was too afraid to post before getting approved and jinx myself into being denyed.

I spent a lot of time reading other people's insurance stories, looking to see where I might stand with mine. There are so many variations with each company as to what is required to get this surgery: Six-month supervised weight loss programs, psych evals, BMI over 40 and co-morbidies...I fully expected for my approval (or denial) to take a few months.

All I can say now is "WOW!" I went to the seminar with the surgeon on January 24th and my paperwork was submitted to the insurance on January 28th. I took the advice of another "bandster" on this forum and called the care coordinator at UHC daily. I was approved on Thursday, January 31st!

I didn't even get to turn in the letter that I had requested from my PCP stating why I should have this procedure. I do have a BMI over 40 and a couple of co-morbidies, but no clinicals were documented!! Just what I wrote on the paperwork at the surgeon's office.

As strange as all of this was to me, I am grateful to be approved. It is insane to read about people on here with the same insurance who are jumping through hoops to get approved when there's those of us who get approved with very little effort. I know it boils down to what your company will agree to pay for (and with a weight loss surgery exclusion on the policy, it keeps the rates down...or so sayeth my human resource dept. ).

I was glad my husband was offered UHC. We pay double what we were paying for Aetna and we have a $4000.00 out-of-pocket max for the family, but it still beats trying to pay cash for this surgery.

Good luck to all of you out there "fighting the fight". I wish you the best and hope for your speedy approval.

[NYGMEN 0]

Congrats!!!!

The Insurance battle can be hard. I had to drop mine (Aetna-turned down 2x) that I had been paying into for year and picked up my wife's (United HC). We just joined the plan on 1/1/08 and was approved 5 days after they got my paper work for the first time. I know it goes by each company's plan but it felt like UHC returned calls and wanted to work with us to get this done. Aetna just felt like they wanted a way out of paying for it. On paper the surgery is covered on both.. But what's on paper and how they apply it is not always the same.

Good luck with everything!!!!

[AngelaW 0]

Nygmen-

Congrats to you as well! I felt the same about UHC...never had a problem talking to anyone and they were all very helpful. I actually had to hang up and call right back because I just didn't believe that it had happened so quickly!

[buttercup456 0]

I submitted my paperwork on the 30th of Jan. with UHC. So hopefully I will hear something next week as to approval or not! But hearing about your stories is very encouraging. I know the banding can take place shortly after you have been approved so I am very excited about that.

[thin2bme 2]

I'm also glad to hear that UHC is approving very fast. My paperwork was submitted to UHC on January 31, so I'm hoping to be approved this coming week too. I'm hoping to be banded in March or early April.

[jacks9036 3]

Make sure you know your policy on UHC. I was approved and banded over 3 years ago. Company made some changes and BOOM! I am now cash pay due to policy changes and no Biatric coverages as of June of this year. So instead of my twenty dollar copay. I now pay 55.00 for the fill, 40 copay...so 99 bucks everytime I go to the dr.

Make sure you find out what UHC covers and make sure they are fully aware that it's long term care. They pay for the dr visit but I have to cover everything else.

[AngelaW 0]

Hi Jacks9036-

So very true!! We went into this process knowing that it was a possibility that we may not be offered UHC next year. I forgot to mention above that my husband is also getting this surgery (approved on the same day!). For us to only have to pay $4000.00 (maximum out of pocket for the family) is a blessing. Going to Mexico, which was our next option, would have been closer to $15,000 (if not more) not to mention possibly driving back and forth for fills (I have heard that many doctors here will not treat you if you were banded in Mexico...?).

I hate the idea that we may not have this same coverage next year, but even if we have to pay cash for fills...I still believe we will have saved alot of money.

...That said, I am praying we have no complications!

[thin2bme 2]

I just called United Health Care and they told me that I've been approved for surgery. Whoohoo!! Now, I'm just waiting for word from the surgeon's office for a date, I am so excited.

[Ellisa 6]

Doing the happy dance! This is such a happy post! Congrats to all of you, see you as bandsters soon!

[Sue40 0]

My understanding of UHC is that the plans vary widely, depending on what company you work for. My policy is through a large financial services company. The paperwork we are provided says surgery is covered if you are morbidly obese. I called UHC and they said all they need is a letter from the doctor listing my height, weight and BMI. As long as the BMI is over 40 I am covered. NOTHING else is required. No monitoring, no diets, etc. I am hoping this is actually how it will work for me! Wish me luck, my first consult is Wednesday.

[sahmof3 0]

My understanding of UHC is that the plans vary widely, depending on what company you work for. My policy is through a large financial services company. The paperwork we are provided says surgery is covered if you are morbidly obese. I called UHC and they said all they need is a letter from the doctor listing my height, weight and BMI. As long as the BMI is over 40 I am covered. NOTHING else is required. No monitoring, no diets, etc. I am hoping this is actually how it will work for me! Wish me luck, my first consult is Wednesday.

I was told the same thing. I have a BMI over 40, but my co-morbidities are not being treated with medicine yet. I was approved in 4 days.

On another note my friend had to wait ~ 1 month to get her approval. We both have UHC and are using the same doctor, but her paperwork was not received at first, not sent to the right fax number, something was missing, etc. From what I have seen most people get approved very quickly, but there are a few that it takes a while. Call the insurance company to make sure they received the paperwork. Call everyday to see if it has been approved.

[mom007 0]

I am STILL waiting for approval from UHC. My paperwork was originally submitted Jan 29th, denied, then resubmitted Feb 8th. I'm still waiting. When it was resubmitted, they put my surgery date as Feb 22nd and so I've been calling everyday. In the past few days, I've even began calling in the morning and again at night. All because I had read about the 2-3 day approvals, so surely mine won't take that long, right? No, I'm still waiting. And to top it off, this morning when I called, the guy on their end was looking at my case and said, "you've been calling EVERY day?" With a shi++y tone in his voice. Um, yeah, I have been calling every day because last week 2 different people in your department told me to do just that because it looked to them like it was just a matter of days before my approval would come through.

I'm just frustrated.

Congrats to the rest of you tho! I'll get there one day just apparently not soon!

[krazygrl77 1]

I have UHC also. Here is my story so far...

I called and got the requirements for the surgery..

• have to be over 18
  
• BMI of 40 or more (or 35 with 2 co morbids)
  
• use a doc that is in the Bariatric Center of Excellence

So i did all of these and found a wonderful doc. Had my appt 2-8, they sent in my paperwork 2-11 and I got a call from UHC on 2-13. I was thinking WOW this is too good to be true. Well it was... the doc i wanted to use was in the plan but his facility was not. Said the only hostpital i could use in Louisiana was Ocshners in New Orleans. That's 6 hours from me!!! They didn't tell me that when i called them TWICE to get the requirements.

The funny/odd thing is the doc that I want to use has done MANY people from the place where i work with the same insurance and never had a problem. So the girl that does the insurance wanted the lady's name i talked to at UHC. So she calls her and she wouldn't HEAR of looking into another hopspital. She said I HAVE to use such and such... so she told her to drop my case. She resubmitted it using the hostpital they always use(because i did want to use the oupatient one) and now i'm still waiting. That was on 2-14. I want to call but don't want to pressure them again!!! lol

Good luck to all of you all that had no problems!!!

Take care!

[bluekygirl 0]

I only wish I had the experiences with UHC as most of you guys. There is a direct clause in my policy that states they will not cover any surgery for obesity. So I guess I'm cash pay, although I wish there were another way.

[Ellisa 6]

Is there a possibility that your insurance could change in the near future? If it's through an employer perhaps if they are shopping around, they might consider adding it. Worth checking.