United Health Care Insurance

[Sleeve1stFitNext 924]

I did not get diagnosed with pre-diabetes until November of 2016. They still approved me. I think it has to do more with what the surgery can prevent. If you have been dieting on and off then that shows you have been trying. What also helped in my case is the fact that my weight plus working out caused me to break my ankle. My suggestion is to call UHC speak with a Representative. Also ask them to check in with the Pre-Authorization department.

[JamesGator 2]

Thank you so much! I appreciate your help. I'm nervous b/c when I asked the nurse as part of the Optum health she seemed annoyed with me and was like "yes, you needed to have the co-morbidity at the time your BMI was under 40" but that another person I spoke with said she didn't know and I think I was confusing her.

I'm going through the process of calling any doctor I can think of that I may have visited over the past 5 years to get my medical records. It doesn't help that I had two babies during that time period and my pregnancy stats don't count (I mean, i get why they don't count, but finding a medical record for a non-pregnant visit during these years is proving difficult).

I just want to make sure i'm not doing all this work for something that won't get approved. I'm trying not to get my hopes up, but too late, they're up

[darstvader 31]

You'll be ok, James. Just don't do too well on the 6 month diet or they will deny it saying you can lose it on your own!
Instead of dealing with this on your own and going through the motions of calling UHC directly, you're much better off finding an In Network doctor (usually one of their conditions too) and getting them to do all this for you. Once you've found your surgeon, they can do most of the communication with the insurance carrier and take the stress of you. Hope this helps!
(I'm a health care insurance broker for what it's worth!)


Sent from my iPhone using the BariatricPal App

[JamesGator 2]

I went to the information session w/ the surgeon (the only one in my area considered a Center of Excellence) and then had my first appointment at their office last week. The doc seemed okay, but the insurance coordinator person was not impressive. He was the one that made me feel my five year history would not cut it. I literally drove home in tears. ARGHGHG.

Also, he made me feel like my weight loss program was questionable. I did a medically supervised weight loss program (I didn't do the injections, but I did take the appetite suppressants). I lost weight, but put it back (and then some).

I wish this wasn't messing with my head so much. I like cut and dry, all this ambiguity is stressful.

[JamesGator 2]

1 hour ago, Thejeweledsleeve said:

I did not get diagnosed with pre-diabetes until November of 2016. They still approved me. I think it has to do more with what the surgery can prevent. If you have been dieting on and off then that shows you have been trying. What also helped in my case is the fact that my weight plus working out caused me to break my ankle. My suggestion is to call UHC speak with a Representative. Also ask them to check in with the Pre-Authorization department.

was your BMI lower than 40 in any of your weight history that you submitted?

[Sleeve1stFitNext 924]

My weight history was not a requirement but my surgeon said to get it anyway just in case. When I went in 2015, my 8 year history went back as such:

2009 (18): 151lbs

2010 (19): 193lbs

2011 (20): 216lbs

2012 (21): 239lbs

2013 (22): 254lbs

2014 (23): 278lbs

2015 (24): 270lbs

2016 (25): 260lbs

I rapidly gained weight over the years. My surgeon wanted to know my weight history for his own records. I have been overweight my entire life.

Edited February 16, 2017 by Thejeweledsleeve