@Diana_in_Philly, that is great (and sane, lol) advice! I've noticed too with my carrier that it also depends on who I speak to on their helpfulness....which I guess goes for just about anywhere, tbh. The last person I spoke with basically gave verbatim what was already available in the policy documents already available online, but that doesn't mean the next person won't be helpful. I have spoken to great people there before, albeit on different topics.
Thank you!!!
@snakrysheltie Instead of stressing, call your insurance company. Mine was great about answering questions during the process. I was approved 2 days after the materials were sent - in fact - I got notice of my approval from my insurance company before my surgeon's office. What matters is what your carrier does and not what anyone else's has done - and what they do on your policy. You could talk to others who have the same insurance co but have a different policy and the process could be completely different. Good luck!
I have UHC and my requirements were different except the 6 months of appointments were the same. I didn't need nutrition appointments, ultrasound, or EKG but I needed the sleep study because my neck measured more than 17. I also had to register in UHC's bariatric program. It's very dependent on your individual insurance plan and surgeons requirement. I started in June and had surgery in Dec. It took 7 days to get my approval.
I am writing this to help those whom have United Health Care. Here are the following things to know and tips:
Before reading these tips, contact UHC for confirmation that Bariatric surgery is covered under your plan. Confirm the requirements. Confirm that your surgeon and his associated hospital is In-Network (if they are not, it will be like paying for the surgery without insurance). Make sure you have an understanding of what the insurance wants to see or have done.
1) You are eligible if you have a 40 BMI or Higher / Greater than 35 BMI with Co-Morbidity.
2) Once you find your surgeon, you will have to do 6 months worth of testing, dieting and education.
3) You will have to make 6 visits (once a month). This does not include your consultation.
4) One of your visits will be with a Psychological Evaluation. This will determine your surgeons view and the insurance company's view of your case. They take a look at your mental and emotional health. They ask about your family and your support systems. They may ask you how you feel about yourself. Stay away from the negative views you may have of your body. Understand that they have seen hundreds of people like you and may have some prejudice in regards to whether you will succeed or not. Remind them that you are a person, not a statistic and bring some human to your discussion.
5) Your surgeon may require you to keep an eating and exercise journal. I use MyFitnessPal and I have a FitBit.
6) You will be asked to do an EKG to see how strong your heart is.
7) You may be asked to do a sleep study. Depending on your surgeon, it can be a requirement. In my case, the insurance company denied it. They did not deem it as a necessity.
8) You will have to do an Ultrasound which is to see if you have any issues with your liver (fatty liver disease) or other organs.
9) The next thing is an endoscopy. This requires you to head to an outpatient clinic, be sedated and have a tube stuck down your throat. I learned that I had an hiatal hernia (where part of the stomach enters the diaphragm). This can cause you heart burn. Be aware of H. Pylori. This is a bacteria that can cause ulcers and heart burn as well. It takes a lot of antibiotics to cure. Be mindful that your throats will be sore and some sharp pains may occur as they most likely scrapped some samples from your digestive tract.
10) In between these visits, you will see an dietitian and nutritionist for further help. They will slowly walk you through changing your eating habits. Be honest with them. It is very important in the long run. Also try to keep your weight lost in small amounts. If you lose too much in a short period of time, the surgeon and insurance company will feel like you can lose the remaining weight alone.
11) Your last visit will consist of an overview. The surgeon will check your weight and may discuss further with you about your feelings towards the surgery. Hopefully you are approved by the surgeon. My surgeon was great during the process. I met with him more times than anyone else. He literally kept giving my information and sites to read to understand this tool.
12) They will then submit your information to the insurance company. Now it can take up to 2 - 6 weeks for approval. I was approved in one week.
My fellow UHC Members, I hope this assist you in your endeavors. 6 months will fly by so quickly you won't even realize it.
Hey everyone! I'm new here and just starting out on my journey. My question is - right now my BMI is 41. If I drop below 40 during this process (I don't have another qualifying condition) will insurance deny my surgery?
snarkysheltie got a reaction from dg371 in BMI and Insurance