I posted this awhile back and later felt that the issue had resolved itself and wasn't what I thought it to be. Looks like I may have been wrong.

So here goes..

I've received conflicting answers from UHC regarding my requirements. There are the typical; BMI, 6 month supervised diet and psych eval. All of which I have completed and my file is in the process of being submitted. I'm this close!!! And boom....I hit a big @ss brick wall that has knocked me off my feet this afternoon.

I called insurance to see if they'd received my file. While on the phone we discussed my requirements, etc. The rep then mentioned receiving authorization 6 months PRIOR to surgery. Curious of his answer, I asked him to convey his perception of that statement. Which he did, and I did not like. I then asked him that IF I were to be approved, let's say next Wednesday, does that mean I have to wait an ADDITIONAL 6 months before I can actually have surgery? So, like...August??? His response was yes. This whole scenario makes absolutely no sense to me. Why? Why make a patient bust their rump for 6 months to prove that they CAN follow guidelines set by their provider/nut but receive little to no result? Why have a patient see a psychiatrist, get the go ahead and then wait an additional 6 months? I'm not saying it will, but there is a lot that can happen in a 6 month period. I can honestly say that when my father passed away in 2012, I would not have been emotionally stable if you will, to follow protocol after surgery.

Up until today, I have been under the impression/hopes of having surgery in early March. I have put in my time and done what has been asked of me. And this news has rocked my world. No it's not the worst case scenario. Yes, I can put on my big girl panties and wait the required time. Yes I am even lucky for the fact that my insurance actually covers this. But I simply do not want to. And that is okay. Please do not ridicule me for being upset over this. I guarantee most of you would be just as disappointed if you were almost there and had the carpet ripped right out from under you.

And yes- when I first started this process I did inform my benefits coordinator at the office of what I was told. She said it did not sound correct and she thought the rep had misunderstood what they were reading to me. I spoke with another rep a couple of months later, and she told me that I did NOT have to wait 6 months. However, I will be calling my coordinator tomorrow to request that she call UHC and discuss this with them. When she initially called to verify my benefits, they never mentioned this to her either.

I'm just having a pity party, okay? And in an effort to avoid a bad habit I have almost broken...I am trying not to resort to emotional eating. I just want a big friggin donut right now!!!!!! Maybe a cupcake too..

Edited February 1, 201610 yr by sassyfrass23

Stop calling the insurance company.Let the dr office handle the submission process.Too many calls to insurance sends a red flag...Let the coordinator who does this for a living handle it.

Stop calling the insurance company.Let the dr office handle the submission process.Too many calls to insurance sends a red flag...Let the coordinator who does this for a living handle it.

This!

Let me reiterate...THIS! lol Your surgeons office deals with this so much that it's an art form. Coordinate through your surgeons office. You may have to wait a little longer, BUT....they'll be able to explain exactly what the next step is.

Tonya called back and I shared the information with her! She was just as confused/appalled as I was. So, she said she was going to look over my policy again and then call UHC to discuss it further with them. I'm dying for her to call back and tell me that it was all a big misunderstanding. Preferably before they close today Fingers crossed!!

I'm glad your surgeons office is dealing with everything for you. That's what you pay them for! ( or insurance pays them whatever! Lol)

Sounds like they are saying have it in 6mons b4 surgery...stay on top of this. Something isn't right. Good luck

That's how I perceived it, @@Danita !

When I mentioned that to Tonya, she said that they never submitted before a patient had completed ALL requirements and basically proven to Dr. Nguyen that they were serious about the lifestyle changes that this surgery entails.

So...Tonya called this afternoon, but thanks to my crappy service at home, my phone didn't ring and she left me a fairly vague VM. All she said was that she spent quite a bit of time investigating this this morning and consulted with her administrator. She asked me to call her back on Monday so she could tell me what SHE (yes....she emphasized "I" when she said that last sentence...not that it may mean anything) found out.

When I spoke with UHC last night, they did say that my doctor could submit a request to escalate my status to urgent to possibly override the additional 6 month wait. But, I don't have any present "life-threatening" or critical issues that I could see him arguing to get that approved. However, if I really am required to wait 6 more months, I feel like although it was an honest mistake, it was still their mistake. And they should try whatever they can to help get this expedited. I tried to bring attention to this in the very beginning and because Tonya had never heard of it before, she thought the reps who relayed the information to me were wrong and basically said not to worry about it. So here we are 6 months later and she's finally investigating.

Grrr!!

I've always enjoyed my weekends...who doesn't? But I guess I will be eagerly awaiting this weekend to pass so I can call her first thing Monday.

I'm sorry this has happened. I hope ur wknd goes by fast as well. Surely you don't have to wait another 6mon. I'm going into my 2nd month...insurance required 4mon

@@sassyfrass23

I totally understand why you would be so upset, I think I would have seriously cried.

I really hope that you get answers on Monday and that everything works itself out.

Hugs! Oh, and hands off the donut box! LOL!

Hands have been tied up to prevent any cheating, @@Djmohr !! And trust me...it's taking everything I have not to cry. I'll hold the tears back until Monday. They'll either be happy or sad tears...

Here's a question for everyone:

I had my policy printout that my surgeon's office pulled when they verified my insurance on day 1. I just reread it and never found the statement about 6 additional months of waiting or the prior auth requiring 6 months.

So- how can they have my policy worded one way for me or any of us (patients) to see, but have special stipulations on their side that we're unaware of? I would think UHC would list everything out in the open and have it all written in black and white...even if it was "small text." This just sounds sneaky to me. And my obsessive/control freak side is in full swing. I have got to chill.

Edited January 30, 201610 yr by sassyfrass23

Is it possible UHC updated its Bariatric policy on January 1st?

Is it possible UHC updated its Bariatric policy on January 1st?

I don't think so. All of this came about when I began the process in 2015 :\

I was denied. My insurance excluded this surgery. I am having to pay cash price. But it's totally worth it to me.

I hate to hear yours was denied @@jantra12 ! But so glad you can still go through with it.

Unfortunately- self pay for the bypass is not an option for me. $70,000 - $80,000 is just not a realistic expense for me

Oh gosh, I feel your pain. My surgery was canceled/put on hold three days before my pre-op diet was scheduled to start because of an administration mistake. I went bananas. Literally reaching for xanax upset. You will eventually get your surgery and it will probably be when you originally thought it was but the uncertainty is awful. I did eventually get the surgery but that pre-op snafu still leaves a bad taste in my mouth. Once you do get approval and move forward try really hard to put this emotional roller coaster behind you and start fresh. Good luck, Im rooting for you!

@@sassyfrass23 I hope everything works out for you!! ????????

@@Missy407 that's horrible! If I were 3 days away from surgery and experienced that, I would have had a complete melt down. I'm so glad it all worked out for you in the end though! The thought of delaying my surgery for another 6 months sucks but IS doable. My husband and I have been trying to conceive for 8 years. Which is part of the reason I have decided to embark on the WLS journey. I'm nearing 28, so when I do the math...I'll be 30 when/if my first child is born since I plan to wait at least 18 months before getting pregnant after RNY. I prefer not to have children into my later thirties or early forties...so my biological clock is ticking extra loud at this point. I originally wanted 3 children and would have preferred a 3 year gap between each like it was for me and my brothers. But now I'm forced to reevaluate the entire situation and reconsider my plans and how logical they are now.

Thank you so much @@jantra12 !

Edited January 30, 201610 yr by sassyfrass23