What Did Your United Healthcare Cover?

[DreamsOfSkinny 53]

Optum Health is a care coordination service for long term medical issues' date=' pregnancy, cardiac, kidney, bariatrics, asthma, that sort of thing. I am not sure if every UHC plan has it but mine did. They verified my coverage and sort of pre-qualified me. They were willing to provide me with a list of surgeon's but I went in with a name. In addition I had a RN case manager who contacted me every couple of months just to check on how I was doing. She was the one to call me with the final authorization before my surgeons' office could. I have nothing but good things to say about my experience with them and recommend getting in touch if it is available.[/quote']

WOW! I'm so mad now. I was never told about this at all from Uhc! I just literally read through a 500 page SPD and found the info.

[isajck 229]

WOW! I'm so mad now. I was never told about this at all from Uhc! I just literally read through a 500 page SPD and found the info.

I wasn't told about it initially. I accidentally found it while googling about UHC and bariatric surgery.

[SweetnCurvy 112]

What pre- and post- op services did your insurance cover? What I understand so far is the list below of what needs to be done.

Consultation

6-month diet

Physh eval

x-rays

EKG

Blood work

Follow-up visit with Dr.

Surgery

Hospital stay' date=' etc.

Post-op visits

possibly more blood work[/quote']

My UHC policy covered all of it except for the PCP co pay during my six month doc visits

[DreamsOfSkinny 53]

I wasn't told about it initially. I accidentally found it while googling about UHC and bariatric surgery.

Well i just called and their service is very limited for me. Only really to prevent "clinically severe obesity" patients from having surgery. Diet talk, etc. No help with UhC. But thanks anyways for telling me. I'm still wondering what the PHI info is that they should be sending me.

[isajck 229]

Well i just called and their service is very limited for me. Only really to prevent "clinically severe obesity" patients from having surgery. Diet talk, etc. No help with UhC. But thanks anyways for telling me. I'm still wondering what the PHI info is that they should be sending me.

Surprising but every employer plan is different. Good luck with everything!

[DreamsOfSkinny 53]

Surprising but every employer plan is different. Good luck with everything!

Thanks!!

[JPSnAZ 33]

So far everything has been covered subject to my deductible and copays and co-insurance. I've made sure though to do it all in network. The nutritionist is employed by the surgeon and her services are included in his bills.

From what I understand & was told, mine will cover the same! So far it has.....

[amberdeo 2]

From what I understand & was told' date=' mine will cover the same! So far it has.....[/quote']

Should I call my insurance to see if i qualify or wait for somebody from the doc office do it

[amberdeo 2]

Hello. Im replying to this post because I had a few questions but first off id like to ask. Does it matter how i deal with the insurance? As in should I wait for someone at the doc office to call? Or should I take it upon myself to call and see if my UHC plan provides the benifit?

[Sab964 10]

I would call... the RN case manager was surprised that I had already done so much without calling Optum first. Not that anything wasn't already authorized, but my employer suggested contacting insurance asap to get in the system and have my RN assigned to me. I just like to be ahead of the game because i'm so excited! And I could always call my nurse with questions without bothering the surgeons staff because that's what she was there for

[JPSnAZ 33]

Hello. Im replying to this post because I had a few questions but first off id like to ask. Does it matter how i deal with the insurance? As in should I wait for someone at the doc office to call? Or should I take it upon myself to call and see if my UHC plan provides the benifit?

YOU SHOULD CALL!!!!! My doc's office said I needed 3 years of weight history being over BMI of 40 per my insurance. I wasnt over 40 for 2 of the years so my docs office said I would be denied. I called my insurance and they said "Your plan doesnt require weight history" and emailed me a print out of my requirements. You should know your benefits so things like that dont happen.

[amberdeo 2]

YOU SHOULD CALL!!!!! My doc's office said I needed 3 years of weight history being over BMI of 40 per my insurance. I wasnt over 40 for 2 of the years so my docs office said I would be denied. I called my insurance and they said "Your plan doesnt require weight history" and emailed me a print out of my requirements. You should know your benefits so things like that dont happen.

Well I called right after I posted and they told me I have an exclusion on my insurance for this type if surgery :/

[isajck 229]

Well I called right after I posted and they told me I have an exclusion on my insurance for this type if surgery :/

Sorry to hear this. Maybe if you and/or other employees appeal to your employer they will consider covering it in the future.

[Ashley B 1]

I know this was awhile ago, but I have United and WLS is excluded from my plan too. They said I could have the Dr. write a letter to appeal for coverage. I am in the process of figuring of who to send it and I want as many Dr's as I can to send something to UHC. I want to come out with guns blazing and see what happens. Anyone in my shoes?

[Hevans 3]

If it is an exclusion on your policy then honestly you have a slin to none chance. Right now I am fighting with UHC because I have a extensive history of a bmi over 40, however in 2009 I lost weight from a liquid diet and they are trying to deny my surgery for the 6 months that I was under a 40 bmi (out of 30 years)..uggh