UHC Requirements

[CindyP 0]

Hi, I am wondering if anyone can tell me about your experience with United Health Care. I was told when I called that the only requirement for approval is being morbidly obese, which according to my BMI, I am. I am also on medication for high blood pressure and have arthritis. When I called the Dr's office today to ask if they had sent in for my approval, she said United may require a five yr weight history. Has anyone experienced this and if so how much of an impact will it have on the approval? I have not been this heavy for the past five years, so I am unsure why this would be something they need. Thanks.

[yzplnxg 0]

What I can tell you is that every employers policy with UHC is different. Mine requires the 5 year over 40 bmi or 35 with comorbities such as high blood pressure among others. My doctors office just sent in all mine info. All BMIj's were over 40 except ONE year and that year was 35.5 BMI. Since I had the high blood pressure and Gerd, Asthma I thought I would be approved with no problem. But I received word today that I was denied. My doctor is going to send a letter of medical necessity tomorrow and hopefully that will work. I am going to start researching and working on an official appeal tonight. I feel like UHC have approved others just like me and yet they still are doing everything possible to delay or deny the claim. I feel like I qualify based on the criterea and I feel like I need this surgery for health reasons. I'm not going to give up.

[CindyP 0]

Good luck, I will keep my fingers crossed for you. This has proven to be a very emotional and frustrating process.

[yzplnxg 0]

Please keep me informed as to your progress...

[Shar Pei 0]

I have UHC through a large employer...NOT covered! Even with several comorbidities...so you need to call them and get really good details. Call more then once...you can get different answers!

Good luck! I am going to do it self pay.

[pevansmom 0]

I have UHC through a larger employer as well. I started this process last year in June. In August I was told by the surgeon's office that my insurance required a 6 month weight history. After going through that for 6 months, finally in January I thought I was finished, only to find out the surgeon's office was not satisifed with the information that was filled out by my primary care physican. They would not submit the information to UHC. In the meantime, I decided to start the 6 months over again. However, in July I called UHC and after being on the phone for over an hour and talking to 5 representatives (I wanted to know if I could fax UHC the 6 month history to get their opinion on them), I finally asked them if it was needed. They told me NO! I asked UHC what should I do because I knew the surgeon's office would not open a claim. They told me that I could open the claim and they would then request the documentation that they needed from the surgeon's. I was APPROVED in less than 7 working days! I then had problems getting the surgeon's office to believe I was approved. Finally, last week I called the insurance group and asked them to call UHC to check. Now that they know I am approved, the process is finally beginning to pick back up. I have to have a psych re-evaluation because it has been over a year. Then on September 4th, I am meeting with the surgeon. I am praying that I will be banded in October.

I said all of this to say, don't trust what the surgeon's office is telling you. If I would have checked it out with UHC, I could have possibly been banded by now.