UHC Requirements - What do you think??

[Thin4Anisha 0]

So, as described in another post, I will soon be switching to my companies insurance policy with UHC which DOES cover wls . I called UHC today to get the specifics on getting it covered. Here is what the very nice gentlemen said to me: 1) it must be done in network, in patient at a hospital (thats fine, I kind of wanted to stay one night anyway), 2) must be over 21 years old (I am turning 25)

Anyone else getting excited yet, sounds too good to be true huh...

3) must have a BMI over 40 (I am at 44.4) and

"you have documentation from a Physician of a diagnosis of morbid obesity for a minimum of five years"

Ok, so here is my problem. I have been morbidly obese for two years, and only obese before that. Anyone with experience or an opinion I would appreciate your input on if you think I will get approved?

[sahmof3 0]

I have UHC and my BMI was not over 40 for all five years. It has been over 40 for the past two years, but between 35-39 for the over three. I got approved in four days. Done give up!

[Thin4Anisha 0]

That is exactly what I wanted to hear!!!! Can I just mention here how incredibly excited I am, a little scared as I have never had surgery, but super excited!! Being able to reclaim my body has been something I have been wishing and trying to achieve for years!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Bea1128 1]

Just wanted to let you know I also have UHC and no comorbidities and was approved in a week. During one of those years my BMI hovered close to the 35 mark and it evidently wasn't a problem. Good Luck!!

[jtorie 0]

Was approved with UHC on 3/3 surgery date set for March 18, 2008. Honestly I had no problem with the approval, and I only had two weight marks for 2002 and then 2006. Its the surgeon requirements that were the probelem. While I have been severly overweight my entire life, the approval process took about 10 days which I was told takes 6 weeks. They also told me their requirements will be the same as my surgeons. Honestly I have been through Hell to get everything completed IE: testing, psych, dealing with Insur., trying to get time off from work, work cancelled insur., rush the surgery date. BUT IT WILL ALL BE WORTH IT. By the way, I am 23.

[RickyRoss831 0]

:cursing:I see you all have UHC and got approved with a BMI under 40....in the month of April of '03 just one of my weights was around 301 and i was about 6'2" and my BMI was 38.7 and i was denied cause of that....my surgery date was scheduled for today....TODAY!!!! but on thursday i got a call from my doctors office and they told me that my insurance denied it....but i dont understand is how can they deny it and i was told just a few weeks before that that i was approved and i am scheduled to go into surgery on the 1st of april....then i get a call and they tell me sorry its denied....any help....my doctors office resubmitted it on thursday....and at this moment it is still pending....can anyone give me any answers?

[Cristay30 0]

Ok this is where I'm at. I finally got the approval from the psychologist and he faxed over the letter. I finally got a call from the surgeons office(first and only in 2 months since I started the whole process) to let me know that they have received the letter and that they did have at least 3 yrs of medical history from my PCP. They still need 2 more yrs but I know for a fact I have one covered but have to dig deep for the other. So I'm all happy I'm close to having them send off to get the approval. She says well you know UHC is now having people do the 6 month supvr diet?!? WTF???? So of course I hang up and call UHC the first call they send me to a care nurse. She advised me to just have the surgeons office to just send through what they have. I kept asking what all the requirements are and she just said your doctor has to diagnose you as being morbidly obese. Just have them send your name, age, and weight. :thumbup: If it was that easy you think I would be going through all these hoops???? So now I'm really confused on what to do. I know my insurance covers the surgery but to be this easy is a joke right?

[triser72 0]

I have UHC - not banded yet - just waiting....the doc's office is submitting paperwk to them this week. I have heard that UHC is one of the quickest approvals out there, and that they cover more than the 80/20 rule.

As to what my doc requires - he doesn't require anything the insurance doesn't require. So, no pre-op diet or battery of medical tests for me! Just a psych & nutrition eval with all my doctors records (which states a 5 year history of morbid obesity and co-morbities). All of this is what the insurance rep told me.

I think getting the medical records sent to the surgeon's office was the hardest part so far.

[windycitygal69 0]

I love UHC. They do not need to send you to see a shrink..etc. Yes you have to be morbidly obese. Even if it is less than 5 years you will be fine.

Just make sure your doctor specifically states that you need this surgery.

[Wheetsin 714]

It will depend on your specific plan. UHC doesn't just have one insurance plan, that have many many many. My employer alone offers something like 9 different choices (that's just the UHC choices), and so far several of our choices had big differences in what's required. In fact, several others in my building also with UHC (different plans than I have) don't have coverage for the surgery at all. In other words, there's a chance some of the people saying "I didn't have a problem" also didn't have the 5yr requirement in their plan. I know I didn't.

So -- unless you find someone here with your exact plan, etc. -- take it with a grain of salt. You should call your rep and ask them if there's any way to waive the 5yrs MO requirement - e.g. sometimes in lieu of a higher BMI, they will allow more comorbidities. That way you'll know for sure and won't have any upsets/surprises. With insurance, you need to really understand what your options are, what to expect, and most of all - don't be afraid to really advocate for yourself. Including finding out what your waive options might be.

[moez02 0]

I just changed to UHC 01/01/2008 because of their history with approvals. Wish me luck, initial consult with doc April 8, 2008.:wink_smile:

Edited April 9, 2008 by moez02

[airika 0]

UHC is tricky. It def. depends on your employer and what they have chosen to include in their plan. I have coverage on two UHC plans and only one has morbid obesity coverage. So def. call and ask if your plan has the coverage available.

[vonnie230 0]

Im a state of GA employee. I called UHC a few months ago and asked if this type of surgery was covered and they said no way no how. Then after being on this site, I learned that its best to inquire about the code for the band, which is 43770. Well I called with the procedural code yesterday and they told me that I would have to submit a letter of medical necessity from my doctor. Its not a "your approved" but it definitely isnt a "NO!"

[JudyAnticola 2]

I was just told on the phone that UHC will not cover because of my employer's plan, but I am not giving up. I work for a large company, I can not believe it would not be covered. I could clearly get the medical necessity so perhaps it will be covered. Otherwise I will be a self pay. Like someone else said, I will just drive an old car and live longer!

[yzplnxg 0]

RickyRoss831,

I have UHC insurance and had only one year under 40bmi and I got denied. Did you ever get your approval and if you did.. how?

Nechole