I'm starting to get frustrated! I apologize if I'm not putting this in the right area, but I'm looking for advice. My insurance company told me prior to even meeting with a surgeon that I didn't have a specified length of time to go through the diet and exercise process with a physician. Somehow when the surgeons office called and asked the insurance company for my requirements, they were told a 3 months diet and exercise was required. But when I called them again, I was told no specified amount of time. I get to my third appointment, and I was advised that the insurance required 6 months. What the heck is going on! So I gave them the phone number that I have been calling to verify benefit requirements, and they left a message for my case manager, and she hasn't gotten back to them. So I called my insurance company to see if they could call the surgeons office. Nope! Inbound phone calls only. Ugh! They then told me that it doesn't have to be my case manager that verifies the benefits. So I called the surgeons office once again to tell them to speak with anybody. They are supposed to, and get back in contact with me. I have literally done every other requirement. Why am I getting conflicting information? Why can't we all be on the same page? Am I stepping outside of my boundaries? I feel like I'm bugging everybody about this, but dammit, it's my life/body/time!

I've even contemplated going to a different surgeon. But who knows how much progress I might lose doing that. I just want them to submit it for approval already, I'm getting aggravated!

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Well, I got on the phone again with them and they actually pointed me in the right direction to find the requirements on the UHC website under reimbursements and medical which makes no sense, but when you click in that and scroll to bariatric it's a 35 pages document just about the benefit. So, in all, since my dr's have not received any of my medical records yet, there is still the chance I may not have to wait 6 months.

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Try a 3way call with insurance and surgeon's office.

I went to 2 surgeon but I decided to have my surgery with the third... Why? I had 10 months of supervised weight management with an endocrinologist, neither of the first two wanted to hear anything about that. The third surgeon was like if you have the weight management done, we'll fax over the paper to the doc and we can submit for approval.. I was like thank you, your the first doctor listening to me... In so many words he said the other two were just being greedy milking the insurance for office visits because they can... At that moment I knew why I loved this surgeon... He said lets get the paperwork rolling so you can get approved and get sleeved.. All this insurance nonsense is opening the door for greedy people to make extra money.. Some may say it's not all that much extra on one patient but if you think of all the patients they have it adds up... Really their not giving any medical care during the 6 month supervised diet, you don't need to be an MD to weight someone... The place I'm using is a center of excellence and it shows every step of the way... Good luck to you!

"We can't solve problems by using the same kind of thinking we used when we created them"

Einstein

The place I am going is also a center of excellence, and my approval was very straight forward.

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Me too center of excellence

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My insurance said 6 months of documented weight loss but it didn't say supervised. I have myfitnesspal showing this but I'm confused by how they get the info if it doesn't need to be supervised.

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Do they have a website where uou can print out the qualifications or requirements for the surgery?

☆Jeni☆

Yeah, that's where I got the requirements I have bcbs of tn.

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Usually if they say documented it has to at least be confirmed by a third party....Weight Watchers meetings for instance, but Weight Watchers Online does not count since you enter your weight yourself.

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Do they have a website where uou can print out the qualifications or requirements for the surgery?

☆Jeni☆

Some insurance companies do not post printable docs online sadly; others WON'T email specifics on bariatric surgery, go figure.

I am someone who could get nothing firmly in writing. Fun!

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Do they have a website where uou can print out the qualifications or requirements for the surgery?

☆Jeni☆

Some insurance companies do not post printable docs online sadly; others WON'T email specifics on bariatric surgery, go figure.

I am someone who could get nothing firmly in writing. Fun!

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That is awful, I guess I'm lucky I. That respect I've been obsessively researching insurance. Mine did say that they don't cover the other tests for the surgery, but I asked if I had my pcp put them in as routine and they said they would be covered so I guess that's something to discuss with the surgeon.

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@@gina171, it's your right to know and have it in writing. You pay for the insurance you should know how it is/what it is so to speak. They have to give you something is what I'm saying not meaning it's your fault at all, just the stupid insurance should have mailed you a copy of your ins. They are Aholes sometimes. Can they mail you anytjing? May take longer but it will be in writing

☆Jeni☆

So, I just was notified by UHC that they only Administrate the claims, that my employer sets the guidelines of the benefits. So I called them and asked if the providers office has called to verify my benefits, and they told me that they haven't talked to any providers. I'm getting so frustrated! What do I have to tell the surgeons office to get them do what I want them to do?

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Tell them UHC is NOT youR insurer, they are only the paid administrator for your company's plan.

The rules of your health plan are made by your company, NOT by UHC.

And your company's own plan does NOT have a specified wait.

So they need to call your company's plan administrator (UHC), and give your very specific policy number to get the right info, BC UHC rules are NOT your rules, BC UHC IS NOT YOUR TRUE INSURER.

UHC works for your company.

It's a whole different world.

And THAT'S why some people who carry a UHC card have no wait, and others with UHC have a 3-month wait, and still others have a 6-month wait.

The many flavors of UHC.

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