United Healthcare - Still Waiting On Approval ...

[Estrovan 28]

I'm absolutely terrified that my insurance won't approve me! I'm a 39.1 BMI with plenty of comorbidities - but I'm still scared that since I'm not above a 40 they will turn me down : (

Are there any other United Healthcare folks out there? How long did you have to wait for approval? Are they sticklers for the 40 BMI?

I'm freaking out - it's been almost 2 weeks since my doctor's office submitted ....

Thanks!

[slimthickens 28]

I was a 39bmi with high blood pressure and high cholesterol and I was approved with no problems. It took about a week and a half to hear back but that is due to paperwork and stuff. As long as you have co-morbidities you should be fine. I had UHC for railroad employees.

[Butterflylegacy 64]

I am on UHC, and I was approved 1st letter. I think it depends on the employer who you have insurance through and whether or not they have subscribed and/or allowed their employees to utilize the bariatric services provided by UHC. Thankfully, my husband's employer subsribed to it, and therefore the option was mine.

UHC is pretty specific however in what capacity they will approve you, or at least that's my experience. They require that your surgery be performed in a COE (Center of Excellence), which for me is over an hour away. I thought this was extreme, until I met other people at my surgeon's office who have travelled upwards of 5+ hours just to get to his office, much less the hospital the surgery will be peformed at!

Thankfully, my surgeon is extremely aware of what it takes to be approved by insurance companies, and he seems to have figured out the "system" so to speak. He requires specific tests that help prove his case to the insurance company that the surgery is of medical necessity. The very first visit, he did an x-ray of my abdomen, and diagnosed me with Acid Reflux. He also requires all patients to do a sleep Study (I was diagnosed with sleep Apnea), and a Cardiac Stress test (I never heard anything back about this, so I am assuming I did ok). These tests serve two purposes from what I can tell. 1, as I mentioned, they assist the surgeon with proving to the insurance company that the surgery is medically necessary. 2, it helps to reduce your deductible and out of pocket max.

For me - I have a BMI of 55, so I immediately met UHC's qualification. Having a BMI so high, also meant that I didn't have to prove continued weight loss attempts, etc. My only insurance requirement with my BMI was the psych eval.

I have never experienced this process with any other insurance company, but I have to admit that I preferred UHC's method. They assigned an RN to me, as a case manager. She has kept in contact with me through out the process, and kept me informed as to where my case file was. She was eventually the person who reviewed all of the information provided by the surgeon and others (Sleep Study, etc.) and she called me to let me know that I was approved, before I even got the letter from them stating it.

Good luck with this process!! I don't know if UHC treats their bariatric patients the same across the board, or if it varies by insurance plan, state, employer, etc. All I can say is that my experience with UHC has been exceptional. I have been very impressed!

[Jbtoby 3]

I also have UHC and I have a BMI of 46. It took about 3 weeks to get approval. I was beginning to worry when I did not hear from them but the letter came through on day 22. Hang in there. Hopefully you will hear from them soon.

[alliegb3 112]

I have UHC- bmi of 47. My doctors office called a week after submitting and they said I was approved. I got my letter a week after that

[DianaDominate 4]

I as well have UHC and I was excited to start my process for getting approved..so i started in jan and i had only a bmi of 38 after all my pre req they submitted my info it took about 3 weeks to hear back from uhc and they approved me. I had sched my surgery for a month and a half later..i had to organize my affairs.THEN when i was calling my doc and hospital to see what the fees were going to be (because i want to pay everything out of pocket so that i dont owe anything) i was looking for an exact amount. COME TO FIND OUT my insurance "accidently" approved me and "thank god" we caught it in time. I was so angry i had already planned everything out it was 2 weeks before my surgery and then they tell me they are canceling everything and i have to actually visit a dietician for 3 months before they can approve my surgery.. I was so flippin furious. HOW CAN AN INSURANCE do that to me. Its so stupid. Can you imagine i walk in the day of surgery ive been waiting for so many years to get. then they tell me oops my bad in 3 months. ugh just be safe and be careful. Make sure everything is good to go!! I didnt take the news lightly so i know how devestatin it can be.

[fatiniowa 10]

I have UHC, I called and did a phone prescreen. My BMI is 35 and they said my employer requires BMI of 40+ or something else wrong for 35+. They said my prehypertension should be enough. I had a phone interview with the nurse at UHC call center, she said she would be my point of contact, and advised I can decide for myself after visiting with doctor, but said sleeve is better since band has complications and many have it take out and get fat again. I scheduled a psyc eval for June 4th. Don't know what to expect with that, not sure if I should be contacting surgeon now or later. The point of contact nurse is tough to reach and have only spoken to her 1 time. Although largely due to the fact I work 7 to 4 and she works 7 30 to 5. I'm afraid they will deny me, I sorta feel like I should go on an eating binge, or rather let me my self control take a back seat so I can get to a 36 or 37 bmi so I can have a better shot of being approved. I know thats not good for anyone but I'm afraid they will tell me to lose 10 lbs so I i can be at 34 and change so they can deny me. So it looks like we are worried for similar reasons but I think you'll have a better shot

[Giselle3264 175]

I have UHC and my BMI was 40+ most of the time for the five year period they requested. Knowing this would be an issue, my doctor's office also sent my sleep study from last fall and evidence of hypertension. I also had breast cancer in 2009. My benefits don't state comorbidities matter but they opened my case on a Thursday. It was still pending the next Wed but was approved when I called back that Fri. That's 7 business days. The letter came a few days later but I had everything scheduled by then.

My COE is an hour away because I chose my doctor first and that's the only COE he goes to. There's a COE 7 miles from my house but I wanted Dr. Kim.

Hang in there and keep us posted!

G.

[Amom2twins 58]

I have UHC & although I had to do the 6 month doctor supervised weight loss & a psych eval, I had no problem getting approved for my surgery. In fact, it was approved in one day which made me sooooo happy. I am sure if you have co-morbidities, you will get approved as well. Good luck!

[Cody0709 15]

I got approved last week from UHC, waited 6 days. Call them it will speed it up. My surgery is Wednesday the 30th.

[fatiniowa 10]

I sooooo happy. I am sure if you have co-morbidities, you will get approved as well. Good luck! have UHC & although I had to do the 6 month doctor supervised weight loss & a psych eval, I had no problem getting approved for my surgery. In fact, it was approved in one day which made me

I have no idea what to expect in the psyc eval June 4th. Are they going to see if my uncle touched me in a special place when I was small, or try find out if I don't work out much. I so confused. Please share:)

[Cody0709 15]

I sooooo happy. I am sure if you have co-morbidities' date=' you will get approved as well. Good luck! have UHC & although I had to do the 6 month doctor supervised weight loss & a psych eval, I had no problem getting approved for my surgery. In fact, it was approved in one day which made me

I have no idea what to expect in the psyc eval June 4th. Are they going to see if my uncle touched me in a special place when I was small, or try find out if I don't work out much. I so confused. Please share:)[/quote']

Psych eval is BS, don't worry abou it.

[Mela 6]

I am on UHC' date=' and I was approved 1st letter. I think it depends on the employer who you have insurance through and whether or not they have subscribed and/or allowed their employees to utilize the bariatric services provided by UHC. Thankfully, my husband's employer subsribed to it, and therefore the option was mine.

UHC is pretty specific however in what capacity they will approve you, or at least that's my experience. They require that your surgery be performed in a COE (Center of Excellence), which for me is over an hour away. I thought this was extreme, until I met other people at my surgeon's office who have travelled upwards of 5+ hours just to get to his office, much less the hospital the surgery will be peformed at!

Thankfully, my surgeon is extremely aware of what it takes to be approved by insurance companies, and he seems to have figured out the "system" so to speak. He requires specific tests that help prove his case to the insurance company that the surgery is of medical necessity. The very first visit, he did an x-ray of my abdomen, and diagnosed me with Acid Reflux. He also requires all patients to do a sleep Study (I was diagnosed with sleep Apnea), and a Cardiac Stress test (I never heard anything back about this, so I am assuming I did ok). These tests serve two purposes from what I can tell. 1, as I mentioned, they assist the surgeon with proving to the insurance company that the surgery is medically necessary. 2, it helps to reduce your deductible and out of pocket max.

For me - I have a BMI of 55, so I immediately met UHC's qualification. Having a BMI so high, also meant that I didn't have to prove continued weight loss attempts, etc. My only insurance requirement with my BMI was the psych eval.

I have never experienced this process with any other insurance company, but I have to admit that I preferred UHC's method. They assigned an RN to me, as a case manager. She has kept in contact with me through out the process, and kept me informed as to where my case file was. She was eventually the person who reviewed all of the information provided by the surgeon and others (Sleep Study, etc.) and she called me to let me know that I was approved, before I even got the letter from them stating it.

Good luck with this process!! I don't know if UHC treats their bariatric patients the same across the board, or if it varies by insurance plan, state, employer, etc. All I can say is that my experience with UHC has been exceptional. I have been very impressed![/quote']

I too have UHC through my employer. For my plan, I had to complete 6 months of supervision. During my monthly visits, I saw the nurse, dietician, and my surgeon at each visit. They were also very much aware of the process and ordered the cardiac test, etc. Before I started my visits, I called UHC to confirm that bariatric was even covered. My bmi was 43 and I don't have any comorbidities. Good luck to you!!!

[Mela 6]

Psych eval is BS' date=' don't worry abou it.[/quote']

My psych eval made me feel like I shouldn't even have the surgery. The psychiatrist grilled me on what I knew about the surgery and why I was doing the surgery. I didn't think she would give me the ok. Good luck

[Jbtoby 3]

The psych eval was very simple but there may be some things you want to think about before you go. Why are you doing this? For your health, to make you happy, to solve all your problems (correct answer - for your health). What are you going to do instead when you want to eat? During the psych eval, the evaluator told me she knows people who started smoking and drinking because they needed to replace eating. Not the way to go!! Do you have something to keep your hands occupied - knitting, video games, etc? How are you going to handle the urge to snack?

There are no right or wrong answers to any of these but, they got me thinking about what I was going to do.

Good luck.