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Anyone have Empire Plan NYSHIP -United healthcare ?

dlfnjgirl

By dlfnjgirl, in Insurance & Financing

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dlfnjgirl    6

dlfnjgirl
Posted

Hi everyone! Just had my consult with my surgeon today. I have my first nutritionist appt on 2/12. Dr said that I should go to him to be weighed before each nut. visit. I also have to get the psychologist appt in as well.

For those who have my plan, did the insurance cover the Nut visit and psych visit?

Also what other hoops do I have to jump through to get approved? My BMI is 41 and don't have any comorbidities (thankfully, although would help for insurance approval)

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KristenLea91    13

KristenLea91
Posted

I have the same insurance. I had to have 6 months nut visit, upper GI, EGD and psych eval. No issues with getting approved for surgery. BMI was 42. They covered EVERYTHING. I only I had to pay my copay :) i was sleeved on 1/6/16.

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KristenLea91    13

KristenLea91
Posted

I believe it was my doctors requirements, to check if there is anything else (hernia) that would need to be fixed as well.

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dlfnjgirl    6

dlfnjgirl
Posted

Thanks KristenLea. I was just told by uhc resolution unit that my surgeon should send in his recommendation and whatever documentation indicating why I should get the surgery to the pre-determination unit and because of my 40+ bmi I could possibly get approved without the 6 month diet. Even though I don't have any co-morbidities...yet. I do have a history of hypertension but for some reason I don't anymore, even though I stopped taking my meds 3 years ago.

Congrats on your surgery btw! How are you feeling?

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KristenLea91    13

KristenLea91
Posted

That's great! Even with the 6 month visits, it went so fast.

I feel great. I'm in the pureed stage. Surgery really didn't cause me any pain either. Unless I'm just a great healer. I am down 22 pounds since surgery, can defiantly feel the difference. I'm not regretting it at all :)

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dlp712    11

dlp712
Posted

Can anyone help with United Health Care Choice Plus? Their approval process. I have an appt with surgeon next Wednesday. I have a BMI 35 I am a diabetic, sleep apena, high blood pressure and if that's not enough. One kidney ....

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KristenLea91    13

KristenLea91
Posted

@@KristenLea91 - who was your surgeon and how much out of pocket did you have to pay?

Sent from my iPhone using the BariatricPal App

I had dr. Ramon Rivera from tristate bariatrics in suffern ny. I only had to pay my co-pays, which was 20 dollars for the office visits, and my surgery was the beginning of the year so I didn't have to pay anything at the hospital. It was great.

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Killian    265

Killian
Posted

I have HIP Prime in New York. I have a 4 month wait...Need psych eval too. Everything is covered. I can wait the 4 months..it is good practice and gives me time to read these forums and You Tube video of fellow sleevers. Use the waiting period to your advantage.

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dlfnjgirl    6

dlfnjgirl
Posted

I had to do 6 months of doctor supervised diet since I didn't have weight watchers or Other diet program within the last 2 years. I had my surgery (sleeve) October 6. Also needed psych eval but approval was pretty smooth. Good luck to you. What agency you work for?

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izzy13    117

izzy13
Posted

I work for the state too, when I had my first dr visit I had the empire plan but decided to switch to cdphp last year during open enrollment. Cdphp is easier if your bmi is over 40, they don't require the 6 mo supervised diet.

With a lower bmi and comorbidites I had some issues but was finally sleeved October 12th it's been the best thing ever!

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