Looking for someone that has UHC with Optimum health bariatric resources. I wanna know how long the wait is for approval once paperwork is submitted by surgeon. Not even gonna let the word denial in my head....lol

I have my 4th visit of the 6 month Dr supervised dt. next week. I should be finished up in sept. and already have a tentative surgery date scheduled for late sept. But it all hangs in the balance waiting for approval. Just trying to get some idea how long they take.

Thanks for any and all responses!!!!

I have UHC with Optimum. I really struggled with Optimum because they always called during the hours I said I WASN'T available, and then when I called back I always got voicemail. As a result, I never really got to speak to the nurse and at the end they wouldn't approve my surgery because they said I was unresponsive. So I called and spoke to the supervisor, gave her all the dates of the calls and basically had a fit. I told her it was ridiculous that my company and I both pay such an enormous premium for my healthcare, that my doctors all recommend the surgery, and HER service is the one deciding my fate because the stupid nurse can't call at the right time!?! (Yeah, I kinda went postal)

In the end they expedited my approval and I got the surgery pretty fast after that. But my recommendation would be to stay on top of them and don't be afraid to complain. It's YOUR health, and they work for you. Just waiting for them to get their act together means you will be waiting longer. There was one day I called the supervisor four times. Honestly, I think they approved me just so they wouldn't have to talk to me anymore. They actually approved me before the last piece of paperwork was submitted to them. I didn't care, I got the approval.

How often did you speak with them before your part work was submitted? At the beginning of my process I called them to get all requirements and they told me the bariatric nurse would call me back. I talked to her the one time. She told me she would call me every cpl of months to check on me. I also called to ask her some questions I had and had to leave a voicemail and she also called in the hours I said I wasn't available. I got the information from my insurance coordinator at the surgeons office so I didn't attempt to call again. And to date I haven't heard from her again. Should I be worried about this? Did you speak to the nurse on a regular basis thru the 6 months or just at the end?

How often did you speak with them before your part work was submitted? At the beginning of my process I called them to get all requirements and they told me the bariatric nurse would call me back. I talked to her the one time. She told me she would call me every cpl of months to check on me. I also called to ask her some questions I had and had to leave a voicemail and she also called in the hours I said I wasn't available. I got the information from my insurance coordinator at the surgeons office so I didn't attempt to call again. And to date I haven't heard from her again. Should I be worried about this? Did you speak to the nurse on a regular basis thru the 6 months or just at the end?

I only actually talked to the nurse twice- at the very beginning when she gave me all the requirements, and then 3 days after surgery. All the times she called in between were at the times I specified I wasn't available! I work full time and am in meetings constantly, so I would always call back as soon as I could, but I always got her voicemail. Then of course she would call again when I wasn't available, even though I always left a time frame in my messages. Basically I got the feeling that it was their way of having an excuse not to approve me the first time. But there was no way I was falling for that, not after 6 months of waiting and going through all the tests. As it was, I started on July 18 of 2012 and didn't get approval for my surgery until the beginning of May 2013. It took me an extra couple of months because my surgeon lost some of my test results and I had to chase them down, then Optimum gave me the run-around. If everything had gone smoothly I would have been able to have my surgery in December 2012 instead of May 2013!

I would recommend calling the nurse once a month. Leave a voicemail and document the date & times of your calls. It doesn't matter if you actually speak to someone, just that you tried. And when your six months is up, HOUND them until you get the approval.

Looking for someone that has UHC with Optimum health bariatric resources. I wanna know how long the wait is for approval once paperwork is submitted by surgeon. Not even gonna let the word denial in my head....lol

I have my 4th visit of the 6 month Dr supervised dt. next week. I should be finished up in sept. and already have a tentative surgery date scheduled for late sept. But it all hangs in the balance waiting for approval. Just trying to get some idea how long they take.

Thanks for any and all responses!!!!

I have UHC choice plus and had to go through Bariatric Resource. They basically have everything ready to go. Once my surgeon submitted to them I got the call either the following day or 2 days later. They were very fast, neither the surgeons office or I could believe how quick the approval went. I didn't have to go through a 6 month supervised diet though, they told me my only requirement for surgery is the requirement the surgeon had, of course I had to meet the BMI requirements though.

I have UHC choice plus and had to go through Bariatric Resource. They basically have everything ready to go. Once my surgeon submitted to them I got the call either the following day or 2 days later. They were very fast' date=' neither the surgeons office or I could believe how quick the approval went. I didn't have to go through a 6 month supervised diet though, they told me my only requirement for surgery is the requirement the surgeon had, of course I had to meet the BMI requirements though.[/quote']

Well hopefully once submitted it won't take long an if no issues as rise I can have my surgery in sept as planned. I just have a tight time frame because of work and all....

I have UHC with Bariatric Resources. I have the direct line to my nurse and have reach her three times without issues. She told me that she would call me again at the end of August because I will have only one more weigh in at that point. She said she would call to see how I was doing. It's so weird how different people have different experiences. I do know that my job decided what the requirements would be. So my requirements are 6 months (6 visits once a month over the next 6 months) of supervised diet, Psychological Evaluation, Body mass index (BMI) must be at least 35-39.9 with at least one obesity-related medical condition (i.e. diabetes, high blood pressure, sleep apnea) OR over 40. <== (I'm the 40+ part). Now I did have to pick a doctor that they listed and meet the doctor's requirements. I've heard great things from most everyone who has this type of insurance. Best of luck!

I have UHC with Bariatric Resources. I have the direct line to my nurse and have reach her three times without issues. She told me that she would call me again at the end of August because I will have only one more weigh in at that point. She said she would call to see how I was doing. It's so weird how different people have different experiences. I do know that my job decided what the requirements would be. So my requirements are 6 months (6 visits once a month over the next 6 months) of supervised diet' date=' Psychological Evaluation, Body mass index (BMI) must be at least 35-39.9 with at least one obesity-related medical condition (i.e. diabetes, high blood pressure, sleep apnea) OR over 40. <== (I'm the 40+ part). Now I did have to pick a doctor that they listed and meet the doctor's requirements. I've heard great things from most everyone who has this type of insurance. Best of luck! [/quote']

I haven't had a reason to call the nurse since the one try I made and couldn't get in contact with her. But she told me she would call at 2 months, 4 months, and again when the surgeon submitted for approval. And I haven't heard from her. I think it's time I checked in with her. Just to make sure all is going as planned.

I have UHC with Optimum. I really struggled with Optimum because they always called during the hours I said I WASN'T available, and then when I called back I always got voicemail. As a result, I never really got to speak to the nurse and at the end they wouldn't approve my surgery because they said I was unresponsive. So I called and spoke to the supervisor, gave her all the dates of the calls and basically had a fit. I told her it was ridiculous that my company and I both pay such an enormous premium for my healthcare, that my doctors all recommend the surgery, and HER service is the one deciding my fate because the stupid nurse can't call at the right time!?! (Yeah, I kinda went postal)

I would. Especially if zenandnow had the issues she did. You don't want them doing that to you. I'm glad that zenandnow got it worked out. Insurances can be a serious pain!

Thank you for your replies!!!

Once they have all the information from your doc, they make a decision within 14 days. Mine was right at 10. The nurse case manager I think I talked to twice. I had to go through UHC's 6 month healthy weight program and that was 10 phone calls over 6 months.

Thank you for your replies!!!

SunMoon, I hope your experience is closer to the other posters than to mine! Best of luck to you!

I have the same ins company. My paperwork was submitted on June 20th and i got my approval on July 12th. My case was closed by my nurse bc she stated she never heard from me after i would call and leave several voice messages. I would call back and never get an answer bc she called during my working hours.So my case had to be reopened and a few days later i got a call from her with my approval and we went over basic surgery stuff and any questions i had. So just make sure u call and check in with your nurse from time to time and document times and dates you call but overall the experience was easy.

Wow ... they really need to improve their nurse resources. I'm so sorry that you guys have experienced this.

I made an account here just to reply to this topic.

I have the same insurance. I have hated/appreciated this 6 months but now I am in stress mode. Here is the situation: I have one more call from my wellness coach on the 31st. I have talked to my case nurse twice since I started this, both times she was next to impossible to get on the phone and was rude and condescending when I did get to talk to her. I saw my dietician for my last appointment about a week ago and the surgeon's office told me they were going to go ahead and submit for approval. I asked if they needed to wait for my last call and was told no, as long as I am enrolled it's ok. My case nurse says it will be denied and that I should'nt expect surgery before September. The surgeon is saying August. It already feels like its been forever waiting. I know a couple more weeks won't matter in the scheme of things, but that doesn't change my stress level. I just want the sweet words "you're approved" in my ears. Oh, and a surgery date in August.

Anyone have their surgeon submit for approval before your wellness coaching calls were done? Even if it is only a couple of weeks?

I just spoke to Optum today. The requirements are related to UHC and your employer's insurance contract criteria. I called 3 weeks ago, and was told it could take up to three weeks before I received a call back.

*Additional items may be identified by your BRS Case Manager, based on your situation. The medical centers and programs within Bariatric Resource Services are independent contractors who render care and

Morbid Obesity Surgery Requirements*:

AGE

You must be between the ages of 18-65 years

BMI

Your body mass index (BMI) must be at least 35-39.9 with at least one obesity-related medical condition (i.e. diabetes, high blood pressure, sleep apnea) or over 40.

You can calculate your BMI at: http://www.myoptumhe.../BMI Calculator

NETWORK

You must use a Bariatric Resource Service (BRS) Center of Excellence. If one is greater than 50 miles from your home, you may use an in-network provider.

DIET

You are required to complete a 6 month physician supervised diet, prior to surgery. This means that you have worked with a provider (any licensed physician, nutritionist or Registered Dietician) and had a minimum of one visit per month for 6 months.

During each visit, the provider must document your current weight, what diet regimen you are following and what type and amount of exercise you are performing. Diet must have been completed within the last two years.

If you went to Weight Watchers or Jenny Craig, please provide a copy of all the stamps for 6 months AND at least two physician office visit notes showing appointment date, your weight and that you were participating in Weight Watchers or Jenny Craig. Please use the form that has been provided to you to record these visits.

PSYCHOLOGICAL EVALUATION

You must complete a psychological evaluation within 12 months of your surgery date. Contact United Behavioral Health at the number located on the back of your member ID card.

PROCEDURES ALLOWED

Roux-en-Y, Lap band, Duodenal Switch and Gastric Sleeve are all covered procedures under your plan.

SECOND PROCEDURE

This benefit is limited to one procedure per lifetime while covered under the plan, unless there are complications relating to the initial surgery. A clinical review will be necessary.

I am submitting for revision from band to sleeve and was told that the doctor could submit early if complications were found from the band. She told me that if they submit the review board has 15 days to respond and it normally does not take that long.

I believe that after everything is sent in for a normal review, they have 30 days to respond, but most everyone I know has received a reply in 15 days or less..

The Optum rep told me she would follow up with me in two months but normally, she follows up at 4 months to check in and remind you of the rest of tests needed by your insurance company.

The Optum rep also told me that they go by the BMI first submitted. So if you are submitted with a BMI of 35 and one approved omorbitdity and lose weight, you will still be approved.

Hope this helps.