Hello!!

I have been doing some reasearch and was wondering if anyone had any luck with United Healthcare Insurance. I also would like some information on how to go about seeing if I am a covered candidate for VSG.

Thanks,

Margoboo

I have UHC EPO and I live in Fla. I was denied last week for wls. The reason was because they didn't have my BMI nor my 5 year history. I notified Dr. Jawad's office about this and they assured me that they sent everything over. For the last week I have been going back and forth.

I spoke with the Dr. office and they again assured me that they have faxed over the appeals paper work, but when I called the ins. company top verify they said they haven't received anything. I don't know what to do.

I have no co-morbidites, other than sleep apena, infertility, gerd, I have my 5 year history showing my BMI have been over 40 for the last 5+ years.

In my plan I dont have to have the 6 mos supervision which is great but, I don't know where to turn. I need your help? Should I seek out another Doctor and If so will I have to have them to submit an appeal since I've already been denied? Any help is welcom and appreciated.

Thanx!!

I have UHC EPO and I live in Fla. I was denied last week for wls. The reason was because they didn't have my BMI nor my 5 year history. I notified Dr. Jawad's office about this and they assured me that they sent everything over. For the last week I have been going back and forth.

I spoke with the Dr. office and they again assured me that they have faxed over the appeals paper work, but when I called the ins. company top verify they said they haven't received anything. I don't know what to do.

I have no co-morbidites, other than sleep apena, infertility, gerd, I have my 5 year history showing my BMI have been over 40 for the last 5+ years.

In my plan I dont have to have the 6 mos supervision which is great but, I don't know where to turn. I need your help? Should I seek out another Doctor and If so will I have to have them to submit an appeal since I've already been denied? Any help is welcom and appreciated.

Thanx!!

Please triple check that you dont have to do the six month Diet, My Policy also stated that I didnt have to do the six month diet but I did. It only said I had to do 3 thing 1.) must be 21 2.) BMI of 40 and 3.) Psych eval. I asked the nurse CM and told her that the policy said I didnt have to do it but there was no arguing she said I had to do it. So when I was denied the first time it was cause of my BMI and I thought good at least they didnt deny because I didnt submit a 6 month diet but the the second denial came and thats the nurse case manager said IT HAS TO BE SUBMITTED TO ME AND YOU HAVE TO DO THE 6 MONTH. So they werent even submitting to the right depts of UHC and those depts were just giving the denials even though it wasnt theirs to deny. And after the third denial its final.

Please triple check that you dont have to do the six month Diet, My Policy also stated that I didnt have to do the six month diet but I did. It only said I had to do 3 thing 1.) must be 21 2.) BMI of 40 and 3.) Psych eval. I asked the nurse CM and told her that the policy said I didnt have to do it but there was no arguing she said I had to do it. So when I was denied the first time it was cause of my BMI and I thought good at least they didnt deny because I didnt submit a 6 month diet but the the second denial came and thats the nurse case manager said IT HAS TO BE SUBMITTED TO ME AND YOU HAVE TO DO THE 6 MONTH. So they werent even submitting to the right depts of UHC and those depts were just giving the denials even though it wasnt theirs to deny. And after the third denial its final.

I've been having a similar experience. I was told the same qualifications and told specifically that no diet was needed, this was from three different people. My surgeon's office even called to double check and the were told the same thing. We submitted and I was denied for not having a supervised diet. Each time I called I was told that nothing could be done until we submitted for pre-authorization. I was never told anything about a nurse case manager or about a bariatric resource service. Then I got a call out of the blue from a NCM and she said I should have been speaking to her from the beginning to find out the full information on my policy and that the phone reps are only able to give me general information, nothing specific to my policy. I just don't get it... if they have my member ID when I call, how is it they aren't able to see my full benefits and requirements. It seems like there is a huge disconnect and it's very frustrating. It seems to me that this could become a bit of a bad faith issue on their part, especially if they are spitting out denials when they aren't even the right dept. It's frustrating.... You'd think that paying as much as we do for the plans that we have it'd be easier to get better service.

I've been having a similar experience. I was told the same qualifications and told specifically that no diet was needed, this was from three different people. My surgeon's office even called to double check and the were told the same thing. We submitted and I was denied for not having a supervised diet. Each time I called I was told that nothing could be done until we submitted for pre-authorization. I was never told anything about a nurse case manager or about a bariatric resource service. Then I got a call out of the blue from a NCM and she said I should have been speaking to her from the beginning to find out the full information on my policy and that the phone reps are only able to give me general information, nothing specific to my policy. I just don't get it... if they have my member ID when I call, how is it they aren't able to see my full benefits and requirements. It seems like there is a huge disconnect and it's very frustrating. It seems to me that this could become a bit of a bad faith issue on their part, especially if they are spitting out denials when they aren't even the right dept. It's frustrating.... You'd think that paying as much as we do for the plans that we have it'd be easier to get better service.

yes it was very fustrating and discouraging!!! I didnt quite understand why either but I figure i just grit my teeth, smile, and give them exactly what they want so I can get the surgery!!! As long as they say its covered then unfortunately the ball is in their court! As soon as I gave them that diet I was approved in less then 24 hours. I waited 3 weeks for the first two denials and as soon as everything was submitted in whole and to the right person it too less then 24 hours!!! I couldnt believe it!! Stay Hopeful...Pateince was the hardest for me but they will approve you.

I have UHC EPO and I live in Fla. I was denied last week for wls. The reason was because they didn't have my BMI nor my 5 year history. I notified Dr. Jawad's office about this and they assured me that they sent everything over. For the last week I have been going back and forth.

I spoke with the Dr. office and they again assured me that they have faxed over the appeals paper work, but when I called the ins. company top verify they said they haven't received anything. I don't know what to do.

I have no co-morbidites, other than sleep apena, infertility, gerd, I have my 5 year history showing my BMI have been over 40 for the last 5+ years.

In my plan I dont have to have the 6 mos supervision which is great but, I don't know where to turn. I need your help? Should I seek out another Doctor and If so will I have to have them to submit an appeal since I've already been denied? Any help is welcom and appreciated.

Thanx!!

Just checking in to see how things are. Have you heard anything back from Dr. Jawad's office or UHC? ( I too have Dr. Jawad) I have to do the six month diet and exercise and the labs and the eval. Still have two more months with pcp. I know that my pcp has faxed things to Dr. Jawad. But she is waiting to send UHC their paperwork until my six months is up. She wants to make sure that all of the six months are together. I hope things work out for you and get a date soon. Let us know how it goes.

I need to be on the pay roll lol! I actually found out that my appeal papers wasn't sent in, when they clamied they did. My paper did not have all of my clinicals and that's why I was denied intialy. On top of that I found out through my ins that the appeal papers was sent in on 12/7. I called back to Dr. Jawad office as calmy as possible and confirmed with them tthat they did fax the appeal to the ins. I have been so furious so upon finding out this info. My first try ever I get denied because the Dr ofc dropped the ball isn't that something? Sorry I'm so long!!!!!!!!!! Im waiting.

Blsmbry

Just checking in to see how things are. Have you heard anything back from Dr. Jawad's office or UHC? ( I too have Dr. Jawad) I have to do the six month diet and exercise and the labs and the eval. Still have two more months with pcp. I know that my pcp has faxed things to Dr. Jawad. But she is waiting to send UHC their paperwork until my six months is up. She wants to make sure that all of the six months are together. I hope things work out for you and get a date soon. Let us know how it goes.

My surgery was covered by UHC.. UHC is very particular about their requirements being met. If you fail to meet one of their requirements they will be happy to deny you.. Insurance is a business.. Good luck to all...

I live in Florida and I have UHC ins. wls is covered but I have been denied 2 x. I'm in the process of re-submitting my 2nd appeal by the end of this month. Hopefully persistence will pay off!!1 I'll keep you updates. Good Luck

Hello!!

I have been doing some reasearch and was wondering if anyone had any luck with United Healthcare Insurance. I also would like some information on how to go about seeing if I am a covered candidate for VSG.

Thanks,

Margoboo

I have UHC and am going for my 7th month check up with my nutritionist today. As long as I show a drop they will be submitting my info to insurance for approval. I had to do a 6 month supervised diet (now in my 7th month) and a psch eval for UHC. For my surgeons center (center of excellence) I had to see there nutritionist for at least two months, and there psychologist. have 6 months worth of supervised diet, personal letter from my primary care doctor indicating the necessity for the surgery. I did everything through there center to make sure I am meeting all requirements for both. I called twice to verify if the sleeve is covered and it will be..... AT 100%! I have great insurance and my only out of pocket cost will be my copay of $250 for the hospital stay. Everything else is 100% covered. I am hoping after my appointment today my nurse coordinator will submit to UHC and I will have a quick turnaround on a decision. I do not have any comorbities but I am 25 years old, 313 lbs, and have a BMI of 47.5. I have also included notes from my doctor from the last 4 years showing my weigh in, and meeting with her to discuss my obesity. I meet all UHC requirements so I don't see how they could deny me but I am worried! Hopefully she submits it by the end of the week to insurance and I can finally be on my way.... Once you had everything in to UHC how soon did you hear a decision? I am hoping to have the sugery mid to late March.... I've heard some of you say within 24 hours. That would be FANTASTIC, because then I could finally have a surgery date!