Optum/UHC Choice Plus BRS Nurse ?

[NurseJaci13 11]

I'm at that very beginning of this process and I'm so confused. I spoke with my surgeon and they advised me that they would like me to call my insurance to get the specifics of my policy (I believe they do this as well, it's just a way for them to make us be aware of how our insurance works so we aren't surprised). Well, I called and I got one answer. It didn't seem right based on what I was seeing on here, so I called again...and then I got another answer. I spoke to someone in BRS, and they brought up the 6-month requirements that seem to no longer apply, but they are insisting they are (and sent me papers from 2017 to "prove' it). I reached out to my HR department asking for the specific language of my policy and they are being slow to reply (but I believe they are working on it). I have my first meeting with my nurse case manager tomorrow morning and I am curious what your experience with them has been? Are they able to see your specific policy language or do they just recycle what "they know" even if it's been updated?

About me: 37, F, Iowa. BMI: 39.9 w/ severe arthritis for my age and hypertension. I'm 111 pounds over IBW.

I'm not worried about getting approved eventually, I'm just trying to figure out if the 6-month thing is really something that is policy or not.

[KarmaNina 61]

13 hours ago, NurseJaci13 said:

I'm at that very beginning of this process and I'm so confused. I spoke with my surgeon and they advised me that they would like me to call my insurance to get the specifics of my policy (I believe they do this as well, it's just a way for them to make us be aware of how our insurance works so we aren't surprised). Well, I called and I got one answer. It didn't seem right based on what I was seeing on here, so I called again...and then I got another answer. I spoke to someone in BRS, and they brought up the 6-month requirements that seem to no longer apply, but they are insisting they are (and sent me papers from 2017 to "prove' it). I reached out to my HR department asking for the specific language of my policy and they are being slow to reply (but I believe they are working on it). I have my first meeting with my nurse case manager tomorrow morning and I am curious what your experience with them has been? Are they able to see your specific policy language or do they just recycle what "they know" even if it's been updated?

About me: 37, F, Iowa. BMI: 39.9 w/ severe arthritis for my age and hypertension. I'm 111 pounds over IBW.

I'm not worried about getting approved eventually, I'm just trying to figure out if the 6-month thing is really something that is policy or not.

A similar thing happened to me at the start of my journey in January 2020. The nurse case manager told me at the consultation that my insurance required 4 months of a medically supervised nutrition program. I had already called my insurance and that was not a requirement.

So once done with my Consult I called the insurance again and was told there were no nutritionist requirements other than what the bariatric program requires.
I spoke with the nurse case manager and she said that I had to complete the 4 month requirement. I called the insurance again and was assured that my insurance did not require nutritionist visits. I decided to keep this information to myself and not continue to call the nurse.
It is odd to be told two different requirements but I would tend to lean to the insurance on this occasion. I did speak with my insurance again yesterday as I still am waiting for my surgery and was confirmed what was told to me the first 3 times.
I understand your confusion because I too feel it.

[NurseJaci13 11]

@KarmaNina I just got off the phone with my nurse and I discovered that part of the reason for the discrepancies is because my employer is self-insured, thus my policy isn't really a traditional health insurance policy. Chances are most of our policies are self-insured (something like 60% of large companies self-insure). As a result, my policy requirements are more strict. ugh! I also learned I have a lifetime max of...wait for it...$15,000.00! I know that it is after insurance discounts, so I'll probably be fine, but OMG! I work for one of the largest auto insurers in the US and they are CHEAP! Good to know I guess...I'll just keep letting them pay for my nursing degree so I can quit (honestly, they've paid $25,000 for an education I'll only use after I leave the company, but they limit the amount they'll pay for bariatric surgery?! Ridiculous!) I'm annoyed (maybe even a little bitter), but what can I do?

I also found out that since I've been (virtually) going to WW for the last 3 months, I can count that towards my 6 months my employer requires as long as I see a nutritionist or physician twice in the next three months. EASY. DONE. OKAY. WILL DO.

All this said, my BRS nurse was super nice and really seemed to want to help me get approved for surgery...no hate her way, just issues with my actual employer.

Edited June 12, 2020 by NurseJaci13

[KarmaNina 61]

@NurseJaci13 That is crazy, only $15,000 lifetime max. 😳

I totally understand the self insured policies being different, so crazy. I feel bad that the companies buy these really awful insurance policies for their employees. My husband has a really bad policy as well.
I am disabled so I have a Medicare advantage policy. This particular insurance is pro bariatric surgery for health reasons. 🙏🏼

[NurseJaci13 11]

3 minutes ago, KarmaNina said:

@NurseJaci13 That is crazy, only $15,000 lifetime max. 😳

I totally understand the self insured policies being different, so crazy. I feel bad that the companies buy these really awful insurance policies for their employees. My husband has a really bad policy as well.
I am disabled so I have a Medicare advantage policy. This particular insurance is pro bariatric surgery for health reasons. 🙏🏼

Sending you lots of speedy prayers to get this approved ASAP. Let me know once you hear!

[KarmaNina 61]

@NurseJaci13 thank you! Will do. ❤️

[New&Improved 1,780]

Some surgeons offices will still make you do monthly weigh in before they will accept you. Regardless of what insurance says...

[NurseJaci13 11]

6 hours ago, MIKEYY84 said:

Some surgeons offices will still make you do monthly weigh in before they will accept you. Regardless of what insurance says...

That's true; however, mine doesn't do that. I only have to meet with a nutritionist two times before they accept a patient. If insurance allows it, they will move forward in as little as six weeks.

[jennyhenny0330 38]

I have UHC too and went through Optum. I had to enroll and they required 6 dietitian visits, EGD, Labs, and seeing a therapist. I got a phone call right from my Dr.'s office after my last dietitian visit and the nurse tells me I will be denied if I don't call UHC right away before 5pm. I called UHC and they told me they unenrolled me because I missed a call back in February. My dietitian didn't really ask for weight since it was via phone, I'm guessing. But in the beginning I remember hearing I need to lose 5%.

[loveamv 1]

On 06/29/2020 at 21:08, jennyhenny0330 said:

I have UHC too and went through Optum. I had to enroll and they required 6 dietitian visits, EGD, Labs, and seeing a therapist. I got a phone call right from my Dr.'s office after my last dietitian visit and the nurse tells me I will be denied if I don't call UHC right away before 5pm. I called UHC and they told me they unenrolled me because I missed a call back in February. My dietitian didn't really ask for weight since it was via phone, I'm guessing. But in the beginning I remember hearing I need to lose 5%.

Did you submit your doctor visit with notes? I am in process now with UHC going through Optum too.