I have UHC choice plus. For some reason, UHC will not give me my plan's requirements for WLS in writing, only over the phone. I have spoken to them many times, and they insist there is nothing they can send me. I just saw my surgeon for the first time and we are trying to set up a plan, and they seemed surprised that UHC would not put it in writing. Its important (among many other reasons) because I was told I don't have to have the required 6-month supervised diet. Has anyone had a similar experience? Any solutions?

Can UHC assign you a case manager who can be your "go to" so that you talk to the same person every time you call?

I would have the Doctors office request this. My insurance did the same thing but when they requested it they sent it right over.

Hi there,

Here is the link to UHC's Bariatric Surgery requirements. It's this one they sent to me. To clarify, my surgeon is just taking down my weight once a month, documenting it and will submit the required paperwork. I tried using my weight watcher's weigh ins but it needs to be a physician monitored program and you have to weigh in at the office.

These apply for UHC and Oxford. However, if you are a state employee it will be different. State employees just need to show weight loss attempts and there is no waiting period at all. You will just need to go through a few evaluations and pre-op testing for approval and your surgeon's office will walk you through that.

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf

Bariatric surgery, as a primary treatment for weight loss is proven for the following:

1. Class III obesity (BMI > 40 kg/m2)

2. Class II obesity (BMI 35-39.9 kg/m2) in the presence of one or more of the following co-morbidities:

• Type 2 diabetes
• Cardiovascular disease (e.g., stroke, myocardial infarction, poorly controlled hypertension (systolic blood pressure greater than 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite pharmacotherapy)
• History of coronary artery disease with a surgical intervention such as cardiopulmonary bypass or percutaneous transluminal coronary angioplasty
• Cardiopulmonary problems (e.g., documented obstructive sleep apnea (OSA) confirmed on polysomnography with an AHI or RDI of >= 30 (as defined by AASM Task Force. Sleep.1999;22:667-89)
• History of cardiomyopathy

Additional information for medical necessity review, where applicable:

Bariatric surgery is medically necessary when ALL of the following criteria have been met:

• Body mass index (BMI) = or > 40 kg/m2 or BMI 35.0-39.9 kg/m2 with one or more of the medical comorbidities described above.
• Documentation of a motivated attempt of weight loss through a structured diet program, prior to bariatric surgery, which includes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program for a minimum of 6 months. (NHLBI, 1998)
• Psychological evaluation to rule out major mental health disorders which would contraindicate surgery and determine patient

Edited October 8, 201411 yr by vsgredesignme

The biggest problem is different plans have different requirements. I have uhc choice plan and I have to go through optum. They assigned me a case manager. My requirements are 6 months of a supervised diet and a psych eval as well as a bmi of 40 or greater.

Uhc had no problem emailing me all the information you may wanna call back and speak to a manager or someone who is able to email or mail you something.