Cannot get requirements in writing from UHC

[nj10128 1]

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?

[Miss Mac 6,261]

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?

[raec81 18]

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

[vsgredesignme 3]

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, 2014 by vsgredesignme

[mmurray 24]

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.