Jump to content
×
Are you looking for the BariatricPal Store? Go now!

United Healthcare choice plus 6 month diet requirements



Recommended Posts

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?

Share this post


Link to post
Share on other sites

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 by AZhiker

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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 by SorryNameTaken
Because my computer and I are dumb.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

@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!

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

@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.

Share this post


Link to post
Share on other sites

@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.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Recent Topics

  • Most popular:

  • Recent Status Updates

    • SabrinaGoddess

      I hate these Lovenox shots.  That is all! LOL
      Feeling like a pin cushion.
      I know they are needed and it's only 10 days worth but I really hate giving myself shots. It's one of the reasons I want to be healthy because diabetes runs in my family

      · 0 replies
      1. This update has no replies.
    • SabrinaGoddess

      Yas, I am HOME! Traveling back home was interesting but I made it.
      For the first time in my flying life we had NO drink service due to the turbulence! It was crazy. I had to call the steward to bring me water. You CAN NOT let yourself get behind on drinking! That would be dangerous.
      My new blog post is up! https://sabrinagoddess.com/day-3-4-post-op-doc-visit

      · 0 replies
      1. This update has no replies.
    • SabrinaGoddess

      I am OFFICIALLY SLEEVED! (surgery was Dec 9th, 2019)
      It was an easy procedure for me and I am not having complications. If you want to see part one of my journey go here: https://sabrinagoddess.com/life-on-the-other-side-post-op-wls
      I will be making new posts during this whole process!

      · 5 replies
      1. GreenTealael

        💚CONGRATULATIONS💚

      2. Billy Bob

        Glad you survived . lol

      3. SabrinaGoddess

        @billybob I am thriving and breathing! That's a blessing!

      4. BayougirlMrsS

        yeahhhhhh we are only 3 months apart on the sleeve journey. I found it has been way easier to lose with the sleeve than it was with the band...... although i loved my band. Sleeve was the easiest SX i ever had too.....

      5. SabrinaGoddess

        @bayougirlmrss I was told this is the fastest weight loss surgery, but I am not really looking for extremely fast. I want it to be healthy. This is our new tool and we can use it wisely for sure. Are you taking your biotin and vitamins?

    • SabrinaGoddess

      TOMORROW IS MY DAY! (note this did not post properly so I am still  posting it after the fact)
      I am so very excited! My sister is here with me and my son. I am so excited. My anesthesiologist called me tonight to discuss our plans for tomorrow. I am not feeling nervous at all. Just excited for the future!
      I did buy a few bottles of CFpreop which is really suppose to help you stay hydrated. It's pricey but I feel it's worth it. I tried the Watermelon tonight. I have to stop all liquids after midnight and I go into the hospital at 5:30am for check in. My surgery is at 8am.
      SO HAPPY for this journey!
      You can get the CFpreop on Amazon if anyone is interested. It comes in Watermelon and White Grape.
      Read my night before thoughts on: www.SabrinaGoddess.com

      · 0 replies
      1. This update has no replies.
    • Arabesque

      Today I said I’m an XS or size 8 (Aust) at a clothing store. I never thought I’d say those words and say them with confidence. And when I commented a dress was too big on me I was told it was the smallest size. As was the belt I wanted. 
       
      I tried on a slim fitting singlet dress yesterday & was shocked to realise the lumpy bits on the dress were my hip bones. I have an hour glass shape so I always had hips but never ones that stuck out on the front of my body! 

      I’ve been a size 10 before - for about 5 minutes. While I am now confident about saying I’m an 8, clothes shopping is all still a bit freaky for me. It’s not that I’m focussed on the size on the label. I’m well aware the cut/line of the clothes and the designer’s style will dictate what size I need or if it will suit my body shape. The size is the starting point & it’s starting at an 8/XS/38 which is a big mind set change. It’s thinking a pair of pants will be too small & discovering they are almost too big. 

      While I’m still coming to terms with my actual new body shape and size, I’m very happy to be in this new reality. 
       
      · 4 replies
      1. ms.sss

        Yay!!

      2. ms.sss

        ...ah! I see you are from Brisbane! We lived there for a year when Mr. got a work contract there.

        I have fond (and not-so-fond, lol) memories of the weather there this time of year. It it crazy hot yet?

      3. Arabesque

        Hit 42degress last weekend but this week has been in the rather pleasant low 30s (relatively of course😜). Could still wear jeans but thank goodness for air conditioning. Worse is the drought. Everything is dying or dead. Very sad & depressing.

      4. ms.sss

        I feel ya.

  • Trending Topics

  • Together, we have lost...
      lbs
    ×