UHC Choice Plus PPO

[michelee0901 0]

This is the insurance I have and I am so frustrated and confused. I contacted my insurance company three times before my seminar to see if I would be required for the 6 month supervised diet so I could get started with that ASAP and they said NO. So I went to the seminar, met with the surgeon, met with the bariatric nurse and today I meet the nutrionist. I have my psych eval scheduled for April 8th. So yesterday the drs office secretary calls me and says I need the 6 mos diet I was like Um ok but my insurance says its not required. She tells me they are wrong :cursing: So I call insurance back get forwarded all over the company and again I am told no I just need 40 BMI (which I have) 5 years of weight history and the nutionist and psych eval. Then I get all 5 yrs of weight history faxed to her and call her and she says who told you you needed that me or the insurance and I said Both???? She says Oh no you dont need that!?!? WHAT THE HECK!!! So if you have this insurance can you tell me what was required for you.

Thanks in advance :tt2:

[CarmenPonce 0]

UHC does not typically require the 6 month medically supervised diet which other Insurance Carriers require. UHC is usually one of the easer health insurance carriers to get approval from. I know this because I am not only a UHC member but also a health insurance broker.

Here are a few thing you can do to help you better understand you health benefits.

1) Log on to https://www.myuhc.com and setup an account for your self. This account will be linked to your UHC Health Insurance and should give you some specifics regarding your benefits.

2) Call UHC and get an “EOB” Explanation of Benefits, This is a full explanation of your benefits (not just a summary) which will explain what is required for you to have Bariatric Surgery. Also ask UHC for “EOC” Evidence of Coverage. This will good to have on hand.

3) You should have received an approval letter from UHC stating what (if any) are your bariatric surgery requirements (your doctor should have submitted paperwork to UHC to get approval, you can not do this your self). If the Doctor is saying “you need a six month diet” ask where did you get this info from? Have you received a requirement letter or approval letter from the carrier? BTW… UHC will also send you these letters, so if you have not received them nether has your doctor’s office.

[michelee0901 0]

UHC does not typically require the 6 month medically supervised diet which other Insurance Carriers require. UHC is usually one of the easer health insurance carriers to get approval from. I know this because I am not only a UHC member but also a health insurance broker.

Here are a few thing you can do to help you better understand you health benefits.

1) Log on to https://www.myuhc.com and setup an account for your self. This account will be linked to your UHC Health Insurance and should give you some specifics regarding your benefits.

2) Call UHC and get an “EOB” Explanation of Benefits, This is a full explanation of your benefits (not just a summary) which will explain what is required for you to have Bariatric Surgery. Also ask UHC for “EOC” Evidence of Coverage. This will good to have on hand.

3) You should have received an approval letter from UHC stating what (if any) are your bariatric surgery requirements (your doctor should have submitted paperwork to UHC to get approval, you can not do this your self). If the Doctor is saying “you need a six month diet” ask where did you get this info from? Have you received a requirement letter or approval letter from the carrier? BTW… UHC will also send you these letters, so if you have not received them nether has your doctor’s office.

Thanks sooo sooo much for the info. The lady at my Dr. office has not sent my letter to UHC she is going off what her information from past people has to say but I dont know if that is even correct because she first told me I also needed a 5yr weight history which I do then said No I didnt :cursing: So I have an apt with her today so we will see Thanks again I will def call for those benefits.

I registered for myuhc but it just says bariatric surgergies will be processed by a care coordinator.

[Aurelia 2]

I have the same plan as you and a 6 month diet wasn't required. You need a BMI of 40 and 5 years of documented weight. You can have a lesser BMI but you need comorbidities to qualify.

Once I had all my info it was submitted and in 4 days I was approved. They do send you an approval letter in the mail which is a great reassurance.

I had a BMI of 38 plus two comorbidities...I only had three years of documented weight and I still got approved.

Something doesn't sound right...I would definitely keep calling. Maybe try the care coordination department and see if they can give you a clear answer.

[michelee0901 0]

I have the same plan as you and a 6 month diet wasn't required. You need a BMI of 40 and 5 years of documented weight. You can have a lesser BMI but you need comorbidities to qualify.

Once I had all my info it was submitted and in 4 days I was approved. They do send you an approval letter in the mail which is a great reassurance.

I had a BMI of 38 plus two comorbidities...I only had three years of documented weight and I still got approved.

Something doesn't sound right...I would definitely keep calling. Maybe try the care coordination department and see if they can give you a clear answer.

Thanks so much! Well as an update now. I have called every department at UHC :seeya: The customer service sent me to care coordinator who sent me back to customer service again back to care coordinator and NO ONE could answer my questions :thumbdown: So I am just going to keep my fingers crossed. The lady at the dr's office is going to submitt my letter after my psych eval which is next wed. Then I will find out if I need the 6 mos I will need it :shurg: what can ya do? I will do whatever I have to to be able to get this done :seeya: Thanks for the info

[Chris61 0]

I would talk with your Human Resources and ask them to have the broker contact UHC and find out what the problem is. We had some problems with UHC at first and it was over how one doctor did the letter. So we went to my wife OBGYN and he did the same letter and we faxed it in and called and waited on the phone and got it approved within 15 minutes. I can forward you a copy of the letter that we used. Also I would send it to the in writting along with a copy of everything to the insurance commison in your state and also in the state of your companies head off. I had problems with a claim and so when I sent the appeal to the company I aslo put it in the letter and with in a short time it was paid for in full. It just takes time and that is hard when you want to get banded. If you have any questions just ask.

Chris

[michelee0901 0]

I would talk with your Human Resources and ask them to have the broker contact UHC and find out what the problem is. We had some problems with UHC at first and it was over how one doctor did the letter. So we went to my wife OBGYN and he did the same letter and we faxed it in and called and waited on the phone and got it approved within 15 minutes. I can forward you a copy of the letter that we used. Also I would send it to the in writting along with a copy of everything to the insurance commison in your state and also in the state of your companies head off. I had problems with a claim and so when I sent the appeal to the company I aslo put it in the letter and with in a short time it was paid for in full. It just takes time and that is hard when you want to get banded. If you have any questions just ask.

Chris

Thanks so much Can you forward me the letter? My email is michelee0901@yahoo.com Thanks soo much :thumbup:

[lindac80 0]

hello, i am new to the forum but i am running into the same problem, I have UHC also, i had my first consultation yesterday and i was told that everything looked good and that my insurance did not require a 6 month diet, well today i go in to talk to the nutritionist and the insurance lady told me that i have to have a 6 month diet before even submitting and that uhc emailed her saying that as of May 1 they were requiring this, so i am kind of bummed,

[goodgirlin2003 0]

Hello everyone, I am also new to this site. However am going next Wednesday to have my seminar for a the lap band. I see several of you also have UHC, which is who I have. I was also told no 6 month diet plan is needed if you have a BMI higher then 40. Does anyone have any idea the out of pocket cost of the actual surgery with UHC? I was told they cover 50% after the 150$ copay... that could get extremely expensive and is what I am scared about! I hope this is not the case!

[Aurelia 2]

I guess it depends on the plan you have. I have choice plus and the only out of pocket expenses I had were my doctor's program fee: $600, cost of the nutritionist: 2 visits x $105, Prescription meds: $50. I had a deductible of $255 that I had already satisfied.

I've never heard of having to pay 50%...again check your plan.

[lola0806 0]

I also have UHC Choice Plus and I had to deal with a nurse throughout the process and I needed to have the 6 month supervised diet with my DR. Each plan is written differently, so I would definitely log onto www.myuhc.com and make sure you register and you can check your benefits from there. Once you are logged on you should look under my benefits section I found my info under special services and hopefully you will find some info. Here is the number I had used when I first reached out to UHC about have the lapband done, Since I am in NY I'm not sure if it would be the same number across the US, I guess it won't hurt to try one more call :smile: 1-888-936-7246. Good Luck, hopefully you can get someone to help you out.

[dyoho60 0]

Hello all this is my first post.I also have UHC .My problem is getting my approval letter ,I was told on 3-11-09 that I was approved.I still haven`t got my letter or my doctor hasn`t .I call serve times a week and I have also gave them my doctors fax number.They willn`t give me surgery date until they get the approval papers.I`m getting very upset.

[Aurelia 2]

Call care coordination. They should have given your doctor an approval number. It usually takes them about 14 days to send out the actual letter after you receive approval.

[Gerberdayzee 0]

Hi ... I also have UHC Choice Plus and my doctor's office has been working over a week on the information to send to the insurance company. My BMI is 37.8 and I'm on medicine for hypertension and have PCOS and am prediabetic. I thought this would be enough, but the lady at the doctor's office said that it wasn't a good case. She said she needed more documentation on the hypertension from one doctor and background on the PCOS from another. I contacted both doctors, and the one faxed her over 30 pages on the hypertension including EKGs, an echocardiogram, and lab results. And while, I couldn't get anyone from the endocrinolist, the doctor who diagnosed me with PCOS was supposed to send whatever they had today.

So, in your experience, do y'all think I'll be approved or denied?

I'm trying to stay positive but am really worried that I won't be approved. For the first time in a long time I am excited about my future, and now I'm afraid my dreams of a healthy future are disappearing right before my eyes.

[Aurelia 2]

Gerber,

It is possible that you will get approved. Tell the lady in your Doctors office to submit the paperwork and see what happens. I had a BMI of 38 and had sleep Apnea and hypertension. I was approved in 5 days. I should also add that the coordinator at my doctors office was very reluctant to submit my paperwork and I told her to humor me and submit it.