educationrulz

Hey ChiTown, I thought I'd reply to your post since I didn't get any replies to my post about UHC requirements - that has been kind of frustrating. Maybe us UHCers are not a common group here. Anyway, I have the UHC HRA plan which covers WLS as any other procedure. The main thing I had to do was initiate the process through the Bariatric Resources Center before I scheduled any appointments. If you haven't already done so, you could try calling them to see if they can help you. This is from the benefits site: Bariatric Resource Services is a program administered by UnitedHealthcare and its affiliates. For obesity surgery services to be considered Covered Health Services under the BRS program, you must contact Bariatric Resource Services and speak with a nurse consultant prior to receiving services. The member can access the BRS Service Centers of Excellence Programs at 1-888-936-7246. I would think that you could simply call the regular customer service number on your card to find out if your plan covers a specific procedure. I have never given any codes to anyone so I'm not sure why you would need to do that. I just told them that I wanted the sleeve and they verified that it was a covered procedure. I guess it depends on who you're talking to sometimes, so you might need to call the main customer service number a couple of times until you get someone who is really interested in helping you verify covered procedures. Good luck with getting everything paid for. I'm not sure what I would have done if I hadn't come to this decision and "discovered" the sleeve around the same time it became a covered procedure. I suspect I would be even deeper in debt trying to pay for it.

HI everyone! This is my very first post on the forum. :thumbup: I've been reading posts for several weeks since I made the decision to get this surgery. I decided that instead of doing my usual routine of observing and reading forever (lurking), I'll just jump in and get as much preop support as I can from the great people on this site. VSG has just been added to our WLS coverage options and I'm so excited. This is the only WLS that I've researched that hasn't scared the wits out of me. :biggrin0: I've started the ball rolling with my preop requirements by getting a psych assessment, scheduling my counseling sessions (I'm not the support group type), and getting my PCP on board with the requirement for 6 months of weight loss/nutritional documentation. My question is, does anyone here have some insight on the documentation requirements for insurance coverage? I'm particularly interested in those with UHC policies, but would love to hear from those with other coverage as well. My main concern is being sure that I have the proper documentation for the nutritional/exercise components. My nurse coordinator explained to me that I could do something like weight watchers or go to my PCP and have them document my weight, diet, and exercise once a month for 6 months. I didn't see any point in paying for weight watchers when the PCP visits would be the same cost or cheaper. When I talked to my doctor about it, he readily agreed to complete the documenation for me, but was kind of vague about it. He gave me a handout with a diet plan, so I guess that's what he'll document as my diet. They weigh me everytime anyway, so that's not a concern. But, I wasn't clear on how they'll document the exercise part. When I pushed the issue with the doc and asked how we would document the exercise, he just said something about me needing to do 30 minutes of exercise a day. I guess that's what he wrote in my chart. We all know how dismissive docs can be. I'm no shrinking violet, but I was sick when we we talked about this and was actually focused on my other health issues so I didn't push things as much as I could have. After all this babbling, my point is that I want to know if anyone had any difficulty with this part of their documentation for WLS. Did the insurance company question this aspect of the info sent in? Did you have to go back and provide additional documentation? Or, was it pretty much the formality that it seems to be and that my PCP made it out to be? I plan to contact my nurse coordinator again to revisit this issue but I would love some insight from anyone here who has experience with this. My biggest fear right now is to go 6 months thinking I've done everything right and then get turned down over something so minor. (By the way, I still may add the weight watchers piece just to cover my bases.) Happy to be here, Mary