United Healthcare choice plus 6 month diet requirements

[Puffy-no-more 141]

Hello everyone. I'm new to this and am very nervous about this whole thing. I have been seeing my primary doctor for years about my weight and have tried numerous diets and pills thru my doctor. I have UMR for insurance but they go by the United healthcare choice plus guidelines for bariatric surgery. I have received different answers from different representatives through my insurance place regarding the 6 month diet requirements. Does it need to be consecutive? How far back can those 6 months go? Does it have to be doctor supervised or can I show weight watchers logs? My surgeon office initially told me it doesn't have to be consecutive and can go back 2 years. But I was just doing some reading and saw that some people with this same plan had to have consecutive visits and within the 6 months prior to the authorization being sent in.

Does anyone have any experience with this?

[AZhiker 2,251]

7 hours ago, GG33 said:

Hello everyone. I'm new to this and am very nervous about this whole thing. I have been seeing my primary doctor for years about my weight and have tried numerous diets and pills thru my doctor. I have UMR for insurance but they go by the United healthcare choice plus guidelines for bariatric surgery. I have received different answers from different representatives through my insurance place regarding the 6 month diet requirements. Does it need to be consecutive? How far back can those 6 months go? Does it have to be doctor supervised or can I show weight watchers logs? My surgeon office initially told me it doesn't have to be consecutive and can go back 2 years. But I was just doing some reading and saw that some people with this same plan had to have consecutive visits and within the 6 months prior to the authorization being sent in.

Does anyone have any experience with this?

Go on line and look up their guidelines. Print a copy to study. That is the only way you will know for sure. My plastic surgeon told me blephoplasty was NOT covered by my insurance and I would have to pay out of pocket. Now it turns out my insurance DOES cover it, but needs visual field testing by an eye doctor first. This is what I read for myself, but the doc insisted the plan had changed. He was wrong! Now I have to start from the beginning since the procedure was denied, lacking the documentation. Doctors do NOT always know the details of YOUR plan. You have to look this up for yourself.

Edited November 10, 2019 by AZhiker

[Libby63 57]

Some plans under United Healthcare have changed their 6 month requirement to 3 months. My policy had the six month requirement. My provider sent the request in after 3 months because I had documented WW and I was approved. They called to verify because they were surprised by the approval and were told it did not have anything to do with WW but was because they changed the requirement to 3 months.

[Puffy-no-more 141]

4 hours ago, Libby63 said:

Some plans under United Healthcare have changed their 6 month requirement to 3 months. My policy had the six month requirement. My provider sent the request in after 3 months because I had documented WW and I was approved. They called to verify because they were surprised by the approval and were told it did not have anything to do with WW but was because they changed the requirement to 3 months.

Ok thank you. I reached back out to my insurance company because what I was seeing was that the requirements had been revised in October and they had removed the 6 month requirement. The person I talked to looked deeper into it and told me that they hadn't received that update but could see it online? I don't know. It doesn't make sense to me. My appointment with the surgeon is Monday so I'm hoping to find out more then.

[Libby63 57]

Good Luck. I hope it works out for you!

[Puffy-no-more 141]

Thank you!

[SorryNameTaken 85]

Hopefully your surgeon's office will be able to help you out! I know my surgeon's office would call and get your insurance's coverage details before you ever came in so they knew everything you needed up front.

As far as the diet, most insurance companies require them to be consecutive. I had researched United Healthcare a while back and here is what it says in the documentation about the diet, just know this may not be the same for your particular plan:

Quote

Demonstration that dietary attempts at weight control have been ineffective through completion of a structured diet program, such as Weight Watchers or Jenny Craig. Either of the following in the two-year period that immediately precedes the request for the surgical treatment of morbid obesity meets the indication: a. One structured diet program for six consecutive months; or b. Two structured diet programs for three consecutive months

So it sounds possible Weight Watchers documentation could be possible if it was 6 consecutive months or 3 consecutive months done twice in the past 2 years.

Edit: SO SORRY!! I don't know how or why my computer double posted this approximately 70 times, but it's Friday, so maybe it's as tired as I am! Good luck at your appointment on Monday!

Edited November 15, 2019 by SorryNameTaken
Because my computer and I are dumb.

[SorryNameTaken 85]

Hopefully your surgeon's office will be able to help you out! I know my surgeon's office would call and get your insurance's coverage details before you ever came in so they knew everything you needed up front.

As far as the diet, most insurance companies require them to be consecutive. I had researched United Healthcare a while back and here is what it says in the documentation about the diet, just know this may not be the same for your particular plan:

Quote

Demonstration that dietary attempts at weight control have been ineffective through completion of a structured diet program, such as Weight Watchers or Jenny Craig. Either of the following in the two-year period that immediately precedes the request for the surgical treatment of morbid obesity meets the indication: a. One structured diet program for six consecutive months; or b. Two structured diet programs for three consecutive months

So it sounds possible Weight Watchers documentation could be possible if it was 6 consecutive months or 3 consecutive months done twice in the past 2 years.

[Puffy-no-more 141]

Ok makes sense @SorryNameTaken. My surgeon's office actually called me about an hour ago verifying insurance so they can have all the information available for my appointment on Monday. I guess I'll find out then.

Thanks for your help!

[Chris NH 12]

Hi, I, too, have The UMR / United Healthcare insurance and I just had my surgery November 12. How I understood the requirements I needed to be under the care of the gastric surgeon’s program for six months and showing a weight loss during that time. Also, super important, UMR requires your program/hospital be a COE (center of excellence). One thing I did learn along the way with dealing with UMR is that there is a specialized customer service team that deals with just bariatric questions. If you call the general service number any rep will talk to you but they may not be as versed as this team....you need to ask for them. Once I learned about this team I started getting direct answers to my questions rather than having people dig for answers. Good luck and feel free to message me with other questions.

[Puffy-no-more 141]

@Chris NH thank you! I did not realize that they had a specific customer service team for this. I did meet with my surgeon’s office and they did confirm that they just revised the requirements and that it is no longer 6 months but that they would not give her a specific amount of time. She said basically for me to do 2 months followed by my physician and then they will send in the prior auth and see what they say.
But I’m going to call back tomorrow and see if I can get the bariatric team and try to get a specific answer.
thank you again for your help!

[Chris NH 12]

Hi, I, too, have The UMR / United Healthcare insurance and I just had my surgery November 12. How I understood the requirements I needed to be under the care of the gastric surgeon’s program for 6 months and showing a weight loss during that time.

[Chris NH 12]

@GG33, is your hospital a COE? I’m only mentioning again for in my program there were two people that switched hospitals / surgeons to the one I have after almost completing all their requirements only to find out at the last minute that UMR would not approve the surgery at their hospital. To clarify, they were approved for surgery but just not at the their hospital. Because the program I’m in is so strict they had to start over.

[Puffy-no-more 141]

@Chris NH yes! I found that out the hard way as well. I didn’t go through the whole program with them but had to change to a different doctor because of the COE. I also have to do the psych eval for insurance and that is scheduled for next week.

[Machta 15]

On 11/25/2019 at 7:55 PM, Chris NH said:

Hi, I, too, have The UMR / United Healthcare insurance and I just had my surgery November 12. How I understood the requirements I needed to be under the care of the gastric surgeon’s program for six months and showing a weight loss during that time. Also, super important, UMR requires your program/hospital be a COE (center of excellence). One thing I did learn along the way with dealing with UMR is that there is a specialized customer service team that deals with just bariatric questions. If you call the general service number any rep will talk to you but they may not be as versed as this team....you need to ask for them. Once I learned about this team I started getting direct answers to my questions rather than having people dig for answers. Good luck and feel free to message me with other questions.

Thank you SO MUCH for suggesting that those of us who have UMR to contact the bariatric team there. I have learned so much in the past couple of days . . . the most important thing I have learned is that UMR / United HealthCare Choice Plus have done away with the 6-month requirement. I was told that giving them documentation from my doctor concerning the many different ways I've tried to lose weight over the last 15 years will be sufficient. This is HUGE (no pun intended). Once I choose a surgeon and center, UMR suggested having my PCP send over my entire chart to them for review. Apparently you can never have too much detail. Their policy is to give a decision within 30 days.

I feel so validated. I was really getting irritated at having to go through some 6-month kabuki theater exercise to satisfy a bureaucratic requirement when I've had so many failed attempts (Weight Watchers, Medifast/Optavia, mayo Clinic Online, and tons of exercise). This feels so much more reasonable. Thank you, UMR! And thank you, Chris NH!