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UHC Choice v. Optum Guidelines



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Hi there!

I ran into an interesting issue today. I have the UHC Choice plan through T-Mobile. They use BRS through Optum, which I'm already registered for. I messaged both my Optum Nurse and UHC to get the guidelines for Bariatric Surgery in order to qualify. I should add in here that I work in Prior Authorizations for an insurance company, so I'm really familiar with the whole process and want to make sure things go smoothly because I know how one missing thing, mischecked box etc can mess things up. While attending the seminar for the office I will be having surgery with, the Director mentioned that a lot of companies were moving away from the six month diet requirement and more towards 3 months, especially with the current state of things/restrictions.

Well my Optum nurse messaged me back, and did list a 6 month diet as a requirement. Though what she sent me was just typed out in a message, not an actual document (which is what I was really kind of looking for- a whole clinical guideline).

UHC got back to me and provide a guideline which does not list a 6 month diet as a requirement (except in Maryland by law- but I'm in AZ).

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/bariatric-surgery.pdf

The office I am going through requires 3 months (which I get and I'm totally fine with), but my husband purposely got us the primo insurance this year for all of my health needs. Plus obviously I would rather have it done sooner rather than later. I also have an entire sheet packed full of past diet attempts (including multiple phentermine attempts, xenical, and metformin), and multiple comorbidities that this could alleviate. I'm just worried with everything going on about it getting pushed back really far.

I'm wondering if anyone else has seen these contradict one another? I'm wondering if maybe it has to do with the fact that UHC just changed their guidelines in May?

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