United Healthcare - Just Beginning

[Weitall 15]

Good morning Everyone. I just started my journey with UHC Oxford. I found a surgeon my doctor is on board and I am doing my requirements for the insurance.

With UHC Oxford I have to do the following:

1 referral from Doctor

2 . Attend a surgical seminar

3 Attend minimum of 2 support groups

4 6 months consecutive Weightloss visits with a concerted effort to loose weight.

5 pre surgical screenings and approval

6 psych evaluation.

I am just a bit worried My surgeon sent me for a sleep study and UHC Oxford denied it. Is this normal? Do i have to fight for almost anything? Should I inform them of my wish for Gastric Sleeve?

[lorralei 21]

Ten business days and I am now approved. Next steps - EGD, then surgery date. More to follow.

[lorralei 21]

@@Weitall - you should have been given a brief "survey" by the sleep center to aid in the effort of getting the authorization for the sleep study. Snoring, walking in your sleep, talking in your sleep, sleepy during the day, etc... You can appeal.

Other than each step seeming to take a long time, I haven't had any roadblocks.

[lorralei 21]

And no --- I wouldn't say you are trying to get bariatric surgery. Let the sleep disorder stand on its own.

[chach123 3]

Each UHC plan is different. I have them and my requirements were 1 psych eval, an EGD, and 1 meeting with a nutritionist. My dr required a letter from my PCP. I had no supervised diet plan or anything. I didnt even have to do a preop diet! The only thing is that with UHC, I had to use the "Bariatric Resource Center", so I was given a list of about 7 doctors that I could use for the procedure. If I used anyone else, it wouldn't have been covered. They also provided me with a nurse that could answer any questions I had. She has called already 3 times to check on me. They were really wonderful. I was approved within 3 days of the paperwork being submitted.

Hope you have luck with them!!!

[lorralei 21]

@@chach123 - I've been called several times from BRS. Even though I'm in healthcare and typically abhor extra contact I don't mind this. The insurance requirements for my plan were near non-existent. My surgeon requires more. Glad no one needs the referral from my PCP since he's not supportive of my plan. I'm not overly happy with his new group of late so I may be hunting for a new PCP. Thank you Obama for forcing my single practitioner to have to go to a group to be able to continue practicing medicine. That's a while 'bother topic and way off topic for here.

Hopefully I'll have dates for my next steps - EGD - early next week.

[Weitall 15]

THanks GUys. I see that the oxford plan may be a little more restrictive but they approved my sleep somonography. So i am perplexed at their reasoning.

[lorralei 21]

Got my dates - EGD on 8/27 --- dr on vacation and personal scheduling issue on my part. sleeve surgery on 9/18... Pre-op diet starts on 9/3. For all you cooks out there, I'm looking for good broth recipes. If it isn't a bouillon cube or in a can I don't know it.

[Weitall 15]

You can get bones from your butcher and place it in a pot with some onions, parsely and aromatics with Water and let it boil. That can be a way to make homemade stock.

[Daisy0818 20]

I had to 6 months nutritionist visits, 2nd opinion from.a different doctor, and whatever testing the dr needed. I was approved within 10 days. The 2nd opinion was an added clause by my employer not the insurance company. And use a bariatric wellness center cause my employer gives 1000 back in hsa for getting the wls..

[Applebootom9 164]

I'm definitely going to have him check it out. He was on the phone with them to get reimbursement for something and he happened to mention the surgery and that's when they told him about the 5 year minimum. He told that to the doctor and the insurance lady and they said that wasn't true but then a month later they called him and cancelled all his appointments because the insurance lady spoke to uhc and they said it was truly and that he needed to wait another 2 years. He went to another hospital. And they said that was bull but then the insurance ppl called him back and said in fact that it was true. He had done his 6months and everything. He was devastated. I will have him call another hospital and not mention the 5 years just in case. Hopefully he gets approved.

I was approved immediately without having to go through the 6mths of supervision and all the other things that so many are being told but with that being said I already had a history with my doctor and submitted that information to my surgeons office. Also, I contacted my UHC and asked what would be the stipulations for surgery and was told whatever the doctor required of me. I received approval first attempt. I believe it has to do with the surgeon and hospital that you choose. I wish you and others who are trying the best of luck.

PS don't forget if you already have history with any of your doctors trying to loose weight submit the information it helps.

[lorralei 21]

I think there's a disconnect somewhere. He may need to provide 5 yrs of weight history- that is one of the more common requirements. Rather than go through the hospital I would recommend calling member services number found on the back of the card. Had I not known that I would have missed a requirement for my employer and suffered through NUT and 6 months supervised diet... Not required by the benefit plan my employer chose for us. More money out of my pocket. Of course, my MD requires a few extra things, psych eval and EGD, that my insurance doesn't. At this point I'm $500 away from my maximum out of pocket, so bring it on.

[bwade1 1]

Under our UHC plan we are required to have ONE (1) year of documented weight loss supervision...meaning PHC provider, nutritionist or Weight Watchers. I believe the surgeon I am interested in will do six months prior to surgery but I will have to find another alternative for the first six months. Wish I would have looked into this much sooner.

[ChefSaraKay 21]

Got my dates - EGD on 8/27 --- dr on vacation and personal scheduling issue on my part. sleeve surgery on 9/18... Pre-op diet starts on 9/3. For all you cooks out there, I'm looking for good broth recipes. If it isn't a bouillon cube or in a can I don't know it.

Haha! A classic stock follows the 15-3-2-1 rule! 15lbs roasted bones (veal, chicken, turkey, duck..etc) 3 gallons of Water, 2lbs of mirepoix (2 parts onion, 1 part celery, 1 part carrot for stock they can be roughly chopped) and 1 Sachet d' Epices ( 15 peppercorns, a clove of garlic, a few bay leaves and parsley wrapped in cheesecloth tied to string)

add all to the pot and simmer (never boil!) for 2-3 hours then strain and store. Note that roasting the bones is very important for flavor and color. To roast them just put them on a sheet tray and bake in the oven around 350 degrees until they are nice and caramelized. Never EVER add salt to a stock!

You can then use your stock to make broths and Soups by adding seasonings, veggies, meats etc.

When you get to the soft foods stage you can also use the stock to poach fish, chicken, turkey and duck. Its much more flavorful then baked and you don't have all the added salt that comes from canned.

Thats it for today's cooking lesson I'm just now getting started on my gastric sleeve journey. I have UHC and have to do 6 months diet (non consecutive) psych, sleep study, nutrition counseling and PCP approval. I have visits with my Endo that I can count as weight loss visits so I will have met all requirements by end of October! II only have one nutrition visit and a sleep study left to go for approval. I am hoping for surgery during my Christmas break in December.

[sineadorebellion 19]

I have UHC through an HCA hospital and was only required to have a 3 month supervised diet/nutritionist visits. A friend of mine has UHC that isn't HCA affiliated and needed 6 months, which seems to be most common. Both of us had the same preop requirements, with a sleep study, EGD, EKG, blood work, weight history, etc. Mine needed a weight history, they wanted from within 2 years but I submitted a weight from 4 years ago and that was enough for them to approve my surgery.