Looking for Advice with UHC

[ChiTown 0]

Hi! I am new to all this, but hoping for a little advice.

My insurance only will cover 50% of weight loss surgery. I have UHC Choice Plus. Because I would have to pay so much out of pocket, I was leaning towards the lap band. The more I read up on the different surgeries though, I really feel that the Sleeve is the surgery for me.

I am seeking approval through my insurance, but when I called with the code (listed on this site), my insurance told me this code doesn't exist.

Does that just mean "my" insurance doesn't cover this code? Am I doing something wrong?

I can't afford the full surgery out of pocket... and not 100% sold on traveling to Mexico.

Any advice?

Thanks in advance!

Mel in Chicago

[educationrulz 18]

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.

[Tiffykins 672]

Hey Mel,

I don't have any advice on UHC, but it looks like the above poster has great resources.

I would definitely check out the complication rates on the band especially if you are self-pay even for a portion of it. Plus, the cost of fills. I've had both the band and the sleeve. Sleeve hands down is amazing.

[ChiTown 0]

Thank you both for your responses!!!

I have gone round and round with UHC. Everytime I call, I would get a different answer.

I was beyond frustrated.

After MUCH thought, I have decided to do the Sleeve and do it Self Pay.

I never really felt comforatble with the lap band... and my heart kept coming back to the sleeve. I believe this investment in myself will be worth it.

Again, thank you both for taking the time to respond to me!

[schatzie 0]

I do have UHC and I ask if they cover bariatric surgery and told me yes.

I got a letter from them approving my surgery. Just today I found out they pay me, so I'm really happy!!!

[Lookinupin2010 0]

I have UHC EPO and am in Arizona. I went through my surgeons office (Dr. Chiasson) and they talked directly to the UHC representative and was told that they cover VSG and Lapband. I have started my criteria that was given to me by Dr. Chiasson's office:

letter from PCP with 5 years documented weight, and all weight related health issues.

Psychiatric evaluation

Cardiac evaluation and release letter

Nutritional counseling

Labwork (blood draws)

sleep evaluation (sleep study)

Endogastroscopy

Yes, I haven't been officially guaranteed that they will pay for MY procedure, but I wasn't led to believe from Dr. Chaisson's office that there would not be any other criteria to be met....

Hope this is true......prayerfully awaiting.....:thumbup1:

Edited March 2, 2010 by Lookinupin2010

[kkandrod 1]

Hey lookinup! I have UHC too through my hubby's employer. They said I had to contact some number (assuming it's the same one Mary posted above) before I could see anyone for surgery. I don't know if I'm supposed to do that or if my PCP is supposed to or what. It's all so confusing to me and I'm scared to call too many times and it put a red flag or something on my policy, lol. Maybe I'll call that number myself and just see what they say and go from there.

How long before you are supposed to find something out from UHC? Has all the info been submitted already?

ETA: Ok, so I got excited and called the number that Mary posted and they were closed. Why can't they be open on the weekends and 24/7???? Don't they know that us fluffy peeps need info when we need it and don't want to wait til Monday??? LOL Just kidding, everyone deserves days off, I know that

Edited March 6, 2010 by kkandrod
too add update

[kkandrod 1]

OHHHH LOL, do NOT accidentally dial 1-800 instead of 1-888 for that number Mary posted!! I got some kind of bondage sex number. First it said if you are under 18 you must hang up NOW so I was like well that's cuz they dont want to do surgery on someone under 18 and then this really sexy voice started talking and said something about the number one bondage blah blah blah number. Tooooo funny!!!

[2muchfluff 1]

The Bariatric Resources is kind of like an answering service for the UHC people that run the program. Be prepared to wait a while before they call you back. I waited about 2 weeks and then I was not home when they called. Then they called again about a week later. I got an appointment with a Bariatric Nurse to call me back on 3/10 and she will be able to answer questions, and will be my caseworker, so to speak. Be patient. It will be worth it in the long run.

[kkandrod 1]

So, the contact ppl that I have to call 4 days before seeing a surgeon are the Bariatric Resources ppl? And, it's not a call and let them know that you are going to see a surgeon type thing, you have to wait until they decide to call you back? Which would mean that you couldn't set anything up until then?

Second question, lookinup and Mary have both mentioned in posts that they have to go through a 6 month program before anything can happen. Does UHC make everyone do this and if it is standard for everyone, do you know if you are approved before you go through this 6 month thing or do you do it and there still be a chance that they won't approve the surgery?

I'm kinda feeling like a "what came first, the chicken or the egg?" type thing here, LOL HELP!!

[valleygirl806 0]

If you complete your 6 month program you will probably have to do a psychological evaluation as well....once all that is done you'll be approved. Coordinator told me that of all the INS company's that she works with UHC is the easiest and have the quickest approvals with the least amount of hassles...you shouldn't have any problems.

[kkandrod 1]

Yeah, this 6 month thing's bothering me though. It took me 2 years to decide to go for a WLS period. I don't want 6 months of dieting and losing weight and then not get to have the surgery after that. My BMI is around 35 or 36 now. What if it's down to a 30 by then or something? I can lose weight, I just can't keep it off cuz of my PCOS. So aggravated. Guess I shouldn't be though. Who knows what can happen, I've prayed for favor so the good Lord may make me not have to do all that mess. I dont mind all the testing and psych stuff, I just dont want to have to diet for 6 more stinking months! LOL

[Lookinupin2010 0]

I called Dr. Chiasson's office just this last week, because I had heard from others about the 6 month supervised diet plan also. I was not told anything about this in the beginning, so I wanted to call and make sure that I had my facts straight.

Tracy (Dr. Chiasson's advocate that works with me) once again reassured me that UHC (for MY particular plan does NOT require the 6 month wait, as long as I have a letter from my PCP that I have had a 5 year documented history of morbid obesity. I have had my physicals every year, so I have no problem with that area.

I (in the last 3 weeks) have gone through:

1. Labwork

2. Psychiatric visit and clearance

3. Endogastroscopy

4. 2 (yes 2 !!!) sleep studies (I was diagnosed with sleep apnea with the first visit and had to go back for another one...YUK)

5. a visit with my cardiologist (he also wants me to do a nuclear

stress test next Wednesday before he will write my clearance letter.

6. a clearance letter from my PCP (with documented weight of the last 5 years)

7. and also on Wednesday, I will be meeting with the nutritionist.

So Wednesday, hopefully will be all my appointments needed by UHC.

I have just had to make and go to the appointments...the bariatric surgeons office has done the footwork with UHC (cause they know EXACTLY who to ask for and what to ask for).

In the past years, (before I knew about VSG) I have tried on my own, and got nowhere and only frustrated to the point of giving up.

I feel very fortunate that the 'digging for the criteria' has been done for me this time. I have never gotten this far before, and feel wonderfully excited.

Hope this helps you, and hope that things can be easier for you...Prayers are with you....

Pat:001_rolleyes:

[valleygirl806 0]

My husbands company just switched to UHC (thank God cause they are one of the few that cover the sleeve) my policy requires 6 months supervised weight loss....the staff of the hospital where I'm having my surgery have UHC and they only have to complete 3 months and some don't have to complete any which I hope is the case for you.....I'm finishing up my 6 months and let me tell you, it's like watching paint dry, seriously!!! Let us know how it works out 4 u....will be praying for favor for you in this process.

[2muchfluff 1]

The caller from Bariatric Resources asked me a few screening questions to make sure I was eligible for WLS. Like height, weight, comorbidities, etc. She gave me numbers for 4 different suregeons and told me to go ahead and set up appt with the one I wanted before I got my call back from the bariatric nurse. She told me about the 6 month supervised weight loss, the phsych exam, etc. I have been on supervised diets with a physician before, so I am going to ask if that would count toward my 6 months. Would be nice if it could be retro like that.