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. 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.

7 hours ago, snarkysheltie said:

Thank you SO much, this is immensely helpful!!! I have UHC and like Mandybb I had to enroll in the bariatric program. I've just begun the process though, my first phone consult with the bariatric nurse isn't for 3 weeks. No one has said what weight they go by, though....if I drop below 40 during my 6 month required dieting, will UHC deny me? I'm worried.

Talk to your surgeon about it. Do you have any comorbidities? This would help you.

I don't have a surgeon yet....about the only thing I've done is pass the verbal pre-screening to join the program and schedule my first call with the bariatric nurse. I DO have high bad cholesterol and low good (I forget which is which), and sleep apnea. I know this isn't a comorbidity, but found out today I will be having a knee surgery April 3....and I know that it is partially due to my weight....so I gotta lose it so I don't need the other done. Hopefully that will be a contributing factor for approval.

Hi Thejeweledsleeve and thanks for your detailed description of the process through UHC. I have just begun the process through them, although UHC in my state of Florida seems to run their bariatric program through Optum Health Complex. I just met the requirements for BMI without a comorbidity at 40.7 (they want 40). I actually went through the 6 month consultation with my primary care physician in 2015-16, so hopefully I won't have to do this again. I initially lost 35 lbs and got down to a BMI of 38.4, but my weight went up 12 lbs from Sept 2016-March 2017.

My question is, since I am on the line between qualifying and not qualifying, once I start the program, can I be denied the possibility of surgery for losing weight? How does this work?

33 minutes ago, Bobcats said:

Hi Thejeweledsleeve and thanks for your detailed description of the process through UHC. I have just begun the process through them, although UHC in my state of Florida seems to run their bariatric program through Optum Health Complex. I just met the requirements for BMI without a comorbidity at 40.7 (they want 40). I actually went through the 6 month consultation with my primary care physician in 2015-16, so hopefully I won't have to do this again. I initially lost 35 lbs and got down to a BMI of 38.4, but my weight went up 12 lbs from Sept 2016-March 2017.

My question is, since I am on the line between qualifying and not qualifying, once I start the program, can I be denied the possibility of surgery for losing weight? How does this work?

Well, it all depends on your insurance and what they expect. Some people fall under the BMI limit during the diet but not enough to be disqualified. My suggestion is reach out to the insurance company as well as speak with the Bariatric center. They would be better able to give you an insight on how things would work out.

On 2/24/2017 at 7:21 PM, snarkysheltie said:

I don't have a surgeon yet....about the only thing I've done is pass the verbal pre-screening to join the program and schedule my first call with the bariatric nurse. I DO have high bad cholesterol and low good (I forget which is which), and sleep apnea. I know this isn't a comorbidity, but found out today I will be having a knee surgery April 3....and I know that it is partially due to my weight....so I gotta lose it so I don't need the other done. Hopefully that will be a contributing factor for approval.

High Cholesterol counts, Sleep Apnea counts. Having to get surgeries on bones can also help. It depends on how the doctors explain it to the insurance company when they submit the paperwork.

My surgeon used the fact that I had surgery on my foot to help me with getting approval.

im new here and i have uhc but im trying to get approved for a revision from a sleeve to bypass due to gerd and hernia . my question is will i have to go thru the 6 month evaluation again like i did for the the sleeve

Do you know if they require a 3 year weight history with BMI of 35 with a comorbidity or over 40 with out to qualify?

Does anyone have United Healthcare's HDHP plan? Does it still cover bariatric surgery?

Thought I would add on to this post. I have UHC and I did not have to do an EKG or an ultrasound. I also didn't have to keep records of my food or exercise.

I did have to do 6 months worth of supervised dieting. I had to have a psych evaluation. I did have to do a endoscopy. My final appointment with my surgeon was to answer final questions. I was told approval/denial would be sent within 7-10 business days from UHC. It took them exactly 9 business days for an approval.

I did NOT have to lose a specific amount of weight beforehand and actually gained from my first appointment 6 months ago and still received an approval.

I'm located in Texas and could be different depending on which plan you have UHC. It's been a painless process though. Surgery is scheduled for June 12, 2017.

Do you know if they require a 3 year weight history with BMI of 35 with a comorbidity or over 40 with out to qualify?

I have UHC and they didn't require it.

Hi Thejeweledsleeve and thanks for your detailed description of the process through UHC. I have just begun the process through them, although UHC in my state of Florida seems to run their bariatric program through Optum Health Complex. I just met the requirements for BMI without a comorbidity at 40.7 (they want 40). I actually went through the 6 month consultation with my primary care physician in 2015-16, so hopefully I won't have to do this again. I initially lost 35 lbs and got down to a BMI of 38.4, but my weight went up 12 lbs from Sept 2016-March 2017.
My question is, since I am on the line between qualifying and not qualifying, once I start the program, can I be denied the possibility of surgery for losing weight? How does this work?

Did you meet with your doctor every month for your six months? I'm curious to know if they have any flexibility in the approval process if you qualify otherwise.

im new here and i have uhc but im trying to get approved for a revision from a sleeve to bypass due to gerd and hernia . my question is will i have to go thru the 6 month evaluation again like i did for the the sleeve

Did you have the revision. I'm trying to get revised from band to sleeve and have United Healthcare as well

How long after approval was surgery schedualed???

And who here has united health care community plan???

2 hours ago, nunezy said:

How long after approval was surgery schedualed???

I waited less than 2 weeks to get an answer. They had submitted my paperwork the same day. I believe I was approved on the 10th day of waiting. My surgery was scheduled the same day I got approval.