So, this is what UHC said for MY policy

[kkandrod 1]

We have UHC Choice Plus. I called that number that Mary posted on another thread and they said that they do not service my hubby's employer's policies so to call the regular UHC number. So I did. I was told that the number they said I had to call 5 days before receiving services referred only to the actual surgery, not the consults and testing. That those things would be covered under the regular policy stuff. Let's pray that's true because I want to meet with as many surgeons as I can.

Anyway, according to the rep, there is no required 6 month diet plan. She said if that was a requirement it would have been listed right there with the bmi requirements and co-morbidity requirements. She also said that I should have the surgeon and all my other docs write letters as to why VSG over other surgeries should be what's approved and send those in for a Pre-Determination. Otherwise, if its all just submitted for approval as usual, VSG may not be the surgery they say they will approve.

So, that's where I stand as of now with my UHC plan. I have my first consult with Dr. Merriman in Shreveport on the 24th and am hoping to get some more scheduled in between now and then.

Here we go......

God Bless!

Krystal

[MINI-Me 196]

Best of luck - keep us posted on your journey.

[Lookinupin2010 0]

Best of luck...prayers are coming your way.

[kkandrod 1]

Thanks y'all! Who needs luck when my Father's got in His hands right? I'm believing for awesome things!! Thanks for the prayers!

[fatnomore50 0]

Hope all goes well- Dr. Merriman is the doc that placed my band and I am busy busy busy trying to collect enough financing to add up to the cash pay price. Still several thousand short right now.

[fatnomore50 0]

I meant to say cash price for the sleeve. Sorry.

[kkandrod 1]

fatnomore, is he going to do your sleeve for you too? Feel free to PM me with your thoughts on him, good and bad. I was leaning toward Dr. Norwood but there's no way for me to get to any of his seminars and he won't see me without doing that first. So, that was aggravating and then I heard from my cousin who had him for her vertical band gastroplasty or whatever that thing is called that he had made a MAJOR mistake on her friends band she almost died. So, she mentioned Dr. Merriman and then Grateful Heart on here had him do her sleeve and really liked him. So, that's how I've ended up researching Dr. Merriman now.

[educationrulz 18]

We have UHC Choice Plus. I called that number that Mary posted on another thread and they said that they do not service my hubby's employer's policies so to call the regular UHC number. So I did. I was told that the number they said I had to call 5 days before receiving services referred only to the actual surgery, not the consults and testing. That those things would be covered under the regular policy stuff. Let's pray that's true because I want to meet with as many surgeons as I can.

Anyway, according to the rep, there is no required 6 month diet plan. She said if that was a requirement it would have been listed right there with the bmi requirements and co-morbidity requirements. She also said that I should have the surgeon and all my other docs write letters as to why VSG over other surgeries should be what's approved and send those in for a Pre-Determination. Otherwise, if its all just submitted for approval as usual, VSG may not be the surgery they say they will approve.

So, that's where I stand as of now with my UHC plan. I have my first consult with Dr. Merriman in Shreveport on the 24th and am hoping to get some more scheduled in between now and then.

Here we go......

God Bless!

Krystal

It never ceases to amaze me how different policies under the same insurer can be. That's great that you don't have to do the whole 6 month song and dance. The timing actually worked out for me but I don't like this "counting the days" feeling that I'm having just to get myself through the 6 months. It's all I think about sometimes. :001_smile:

I haven't heard anything about needing to do a pre-determination request with my policy, but I guess I'd better call and ask about it just in case. Thanks for letting us know what you found out Krystal. Hopefully all of us UHCers will be getting good news soon.

[kkandrod 1]

Mary, the way the UHC rep made it sound, it was just something that could be done beforehand if there was a strong case that needed to be made about having VSG versus any other surgery. And because my BMI is less than 40 and ,other than PCOS, I'm not officially diagnosed and on meds for any other co-morbidity so things will have to be explained in greater detail than just submitting for approval as usual. Basically, they can't submit for approval with a BMI above 40 or below but diagnosed with diabetes, HB or anything else and it get approved specifically for VSG for me so I think we may be heading off the long appeal process by basically doing an appeal from the get go with the pre-determination. I hope all that makes sense, I know in my head it does but I don't know if I'm getting out quite right, LOL I'm good at talking in circles and never getting it out in a short and sweet form, LOL

I'm excited though. I'm not getting to see my pcp and ob/gyn tomorrow like I was supposed to though and I was excited about that because I was hoping to get my request for their letters in and them have plenty of time to have them done by the time I meet with the surgeon on the 24th. Now, I won't get to see them until the 22nd and I don't know that that gives them time. I sure was hoping for the pre-determination stuff to be done right after my meeting with the surgeon. I want to be past surgery and feeling good and normal by the time my little boy gets out of school at the end of May so we could enjoy the summer without me having to be on mushies and still figuring out how to eat and stuff, lol. I'm still praying for that to happen though!!

[cwalker 12]

Hi, I'm new..well have been lurking for awhile, I hope I'm not jumping in the wrong place but..I have uhc choice plus too. I thought the Dr. office handled everything but finally snapped to the info on the uhc website. I called,registered with brc in Feb. attended a seminar with Dr. in Houston Tx, the nurse thing is kinda throwing me it's like I have to report to her and deal with Dr. office too. I have to do the 6 mo diet with my insurance but I already had it just hoping they accept it.I'm here in East Texas close to Bmt, it's so nice to have someone to talk to. I've never been on a forum so I hope I didn't post in the wrong place.

[kkandrod 1]

Hi cwalker. Your post is fine where it is. I tell you, it's amazing to me how different policies, even with the same name, can be. I just pray that what the last lady told me was correct. I'm assuming that even the requirements for approval for surgery vary from employer to employer since we both have uhc choice plus and were told two different things.

I guess I'll find all that out soon enough. She assured me a few different times that I did not have to contact anyone until at least 5 days before actual surgery, a care coordinator I think is what it's called. And that if there was a 6 month requirement on diet that it would have been listed in the requirements for approval. I am so ready to go to the doc on the 24th so the insurance stuff can get started and I can find out for sure what's required. I'm praying it's exactly what she said and that everything goes smoothly.

When will you find out if you are approved for surgery or not? What doc are you using?

[cwalker 12]

Well it's a long story...I went online and saw the wls was covered and attended a seminar,with Dr. spivak.. did blood work and ekg and 3 weeks later I was dead in the water...no response from insurance then I found a post on another forum that said you have to call the brs number so thinking" what do I have to lose" I called them, a man said I qualified and said someone would call within a week- and 2 days later Kimberly called,gave memy insurance requirements and told me I would have a nurse case manager and gave me nurse's name and date she would call, it was a 2 week wait so she said go to seminar and appt if I wanted to get started.She emailed me a letter with surgeons in my network to choose from(Spivak was'nt) and a list of requirments. For me it's a 6 mo diet, bmi above 35 with comobidities or above 40 without, and a psy evaluation.and over 21 yrs. I went to see surgeon in Houston Dr. Robert Marvin, and left theoffice with appt for cardio,phone numbers for psy eval.I left my 6 mo. diet with Dr.The brs nurse called and we chatted, she is very nice and told me she needs the 6 month proof of dieting before they submit it to insurance,so dr marvin faxed it to her and I was alittle nervous since they had my height wrong on 3 of the sheets but I havent heard anything since yesterday when it was faxed, so keeping fingers crossed. psy eval on 3/23 and cardio on 4/1 so keeping toes(lol) crossed maybe by mid april thay can submit it, Dr Mavin is supposed to be good but he is 2 hr drive away, hey she also said I have travel benefits of 100.00 a day for 2 people. Not sure if you have to travel, Who told you that you dont need to do anything until 5 days out? I guess if I learned anything it's that they(UHC) are there for us, to answer our questions but you are so close to the 24th you need to do what you are comfortable with. my dh works for kbr and that is where the insurance is from. I hate I wasted 3 weeks with first Dr. but things happen for a reason and I gonna go with that. Ins lady told me Lake Charles was closer for me but I didnt know of any surgeons over there, Marvin's been on TV on tlc The Brandon Story. sorry it's so long but if I can help let me know, I will be praying all works out for you.Carla:smile1:

[kkandrod 1]

Hey Carla. The lady that I called in the benefits dept at UHC is who told me that the 5 day thing was strictly for surgery, not for the consults and stuff. To go ahead with that. I thought that before when I callled they had said before I had any sort of services from a bariatric doctor so that's why I called that brs number and the dude told me that they did not service Shell's UHC policy for bariatric, to call the UHC number and talk directly with them. So, that's when I called the UHC number on my card back AGAIN, lol, and that's the last time when I was told everything. I did call the surgeons office today and asked if they would be verifying coverage and requirements before I came on next week and she said yes they would be doing that so I pray that they call me if they are told something different than I was before I drive the 100 miles up there for nothing that day.

Thanks for the prayers! I'll be praying you hear very soon!! Keep in touch!

[cwalker 12]

Well it sounds like you said each company is different,I wish I had all my testing done, my drive is 87 miles and it does give you alot of time to think about it all, until I hit downtown Houston, the small town I live in has 3 red lights so you can imagine, I kinda wish I had gone with Louisiana, I go to Katy on Tues for the psy. eval. and I know you'll be going to your Dr.on Wednesday and I'll be thinking about you, and before we know it we'll be on the other side, I can't wait.I'll watch for your post on how it goes.Carla

[fatnomore50 0]

fatnomore, is he going to do your sleeve for you too? Feel free to PM me with your thoughts on him, good and bad. I was leaning toward Dr. Norwood but there's no way for me to get to any of his seminars and he won't see me without doing that first. So, that was aggravating and then I heard from my cousin who had him for her vertical band gastroplasty or whatever that thing is called that he had made a MAJOR mistake on her friends band she almost died. So, she mentioned Dr. Merriman and then Grateful Heart on here had him do her sleeve and really liked him. So, that's how I've ended up researching Dr. Merriman now.

I am really new to this whole forum chat blog thing and I admit I do not know how to personal message. I can tell you generally, I am happy with his level of expertise and his knowledge base.:001_rolleyes: