I am writing this to help those whom have United Health Care. Here are the following things to know and tips:

Before reading these tips, contact UHC for confirmation that Bariatric surgery is covered under your plan. Confirm the requirements. Confirm that your surgeon and his associated hospital is In-Network (if they are not, it will be like paying for the surgery without insurance). Make sure you have an understanding of what the insurance wants to see or have done.

1) You are eligible if you have a 40 BMI or Higher / Greater than 35 BMI with Co-Morbidity.

2) Once you find your surgeon, you will have to do 6 months worth of testing, dieting and education.

3) You will have to make 6 visits (once a month). This does not include your consultation.

4) One of your visits will be with a Psychological Evaluation. This will determine your surgeons view and the insurance company's view of your case. They take a look at your mental and emotional health. They ask about your family and your support systems. They may ask you how you feel about yourself. Stay away from the negative views you may have of your body. Understand that they have seen hundreds of people like you and may have some prejudice in regards to whether you will succeed or not. Remind them that you are a person, not a statistic and bring some human to your discussion.

5) Your surgeon may require you to keep an eating and exercise journal. I use MyFitnessPal and I have a FitBit.

6) You will be asked to do an EKG to see how strong your heart is.

7) You may be asked to do a sleep study. Depending on your surgeon, it can be a requirement. In my case, the insurance company denied it. They did not deem it as a necessity.

8) You will have to do an Ultrasound which is to see if you have any issues with your liver (fatty liver disease) or other organs.

9) The next thing is an endoscopy. This requires you to head to an outpatient clinic, be sedated and have a tube stuck down your throat. (Update: You will need to have lab work done no more than 1 month prior). I learned that I had an hiatal hernia (where part of the stomach enters the diaphragm). This can cause you heart burn. Be aware of H. Pylori. This is a bacteria that can cause ulcers and heart burn as well. It takes a lot of antibiotics to cure. Be mindful that your throats will be sore and some sharp pains may occur as they most likely scrapped some samples from your digestive tract.

10) In between these visits, you will see an dietitian and nutritionist for further help. They will slowly walk you through changing your eating habits. Be honest with them. It is very important in the long run. Also try to keep your weight lost in small amounts. If you lose too much in a short period of time, the surgeon and insurance company will feel like you can lose the remaining weight alone.

11) Your last visit will consist of an overview. The surgeon will check your weight and may discuss further with you about your feelings towards the surgery. Hopefully you are approved by the surgeon. My surgeon was great during the process. I met with him more times than anyone else. He literally kept giving my information and sites to read to understand this tool.

12) They will then submit your information to the insurance company. Now it can take up to 2 - 6 weeks for approval. I was approved in one week.

My fellow UHC Members, I hope this assist you in your endeavors. 6 months will fly by so quickly you won't even realize it.

Remember education is the key to success.

Sent from my iPhone using the BariatricPal App

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

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

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.

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?

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, 20179 yr by Thejeweledsleeve