United Healthcare Denial?

Cayden'sMa · July 21, 2008

Hi! I'm new to the site and was wondering if anyone has dealt with United Healthcare (Caterpillar)? I've been to see the surgeon and after talking with the adminstration was told that in order for United Healthcare to pay, I would have to have five years of documentation along with a BMI of 40. So, I'm guessing, I'm already going to be denied, since my BMI has never been 40. Has anyone ever been denied because their BMI was 39 and not 40? Thank you!:confused2:

Bea1128 · July 21, 2008

Every UHC plan differs. It will depend largely on whether or not your company has any weight loss surgery exclusions. I have UHC and my husband's company doesn't have any exclusions; however, they did require 5 years of documentation and a BMI of 35 w/ comorbidities or 40+ and no comorbidities. My BMI was slightly less than 40 and I don't have any comorbidities. I was approved in less than a week. I just went to my regular doc and my gyno and got records for the past 5 years. I just requested office notes which states your weight and BP. I was consistently overweight for all of those years. Evidently it was okay because I'm 3 months post-op now. I haven't had to pay for anything out of pocket except for the nutritionist eval. I know I'm very lucky as we have a really good plan. Good luck!!

Grievous Angel · July 22, 2008

I have UHC too and like Bea I had to have 5 years documented of a BMI of 35 or above. Fortunately my Cardiologist had that recorded and I didn’t encounter any problems getting the approval. I suggest calling UHC yourself and let them tell you exactly what your requirements are. I don’t believe in leaving such an important process completely in the hands of the administrators. Good Luck!

Greg

tcbeau · July 22, 2008

I was denied first by UHC because my bmi was 38.4 w/o comobities. My pcp then put me on meds for high cholesterol. Denied x2. Now my bmi is 41 and I am resubmitting, hope all goes well.

Bea1128 · July 22, 2008

Hey Greg! Congrats on your approval and surgery date! Good luck!

tcbeau - good luck on your appeal. I can only imagine how frustrating that is. Keep us posted!

Melisa1 · July 25, 2008

:biggrin:ok guys....this is the story lol

Speaking of UHC...ive called them several times to have them tell me whats in my policy. They cannot find anything that says im reqired to do a six month diet. The only requirement that it states is that i have to get a letter of pre determination. Do any of you guys know if they can tell you to do the 6 month diet if its not stated? My bmi is 40+ but no co morbids. And yes ive been over weight for more than 5 years for sure! Im dying to know if they are gonna make me do this diet??? do any of you guys know if they can make you do this if its not stated in the policy?:smile2:

southerngirl24 · July 25, 2008

:biggrin:ok guys....this is the story lol
Speaking of UHC...ive called them several times to have them tell me whats in my policy. They cannot find anything that says im reqired to do a six month diet. The only requirement that it states is that i have to get a letter of pre determination. Do any of you guys know if they can tell you to do the 6 month diet if its not stated? My bmi is 40+ but no co morbids. And yes ive been over weight for more than 5 years for sure! Im dying to know if they are gonna make me do this diet??? do any of you guys know if they can make you do this if its not stated in the policy?:smile2:

I have UHC and my BMI was 43 with no co-morbids. I did not have to do a six month diet. I was approved in about 10 days after submitting a 5 year history.

Melisa1 · July 25, 2008

wow...that is wonderful...i hope its the same for me!!! what did you have to do to get the 5 year history? just go to your pcp dr and gyno? I know i have five years documented by my dr!!

Bea1128 · July 25, 2008

I would think that for them to make you do the 6 month diet, it would have to be a written policy; however, you can never tell with insurance companies.

I didn't have to do the 6 month diet either, just 5 years history. I got them copies of the progress notes from my PCP and gyno.

Good luck!!

southerngirl24 · July 26, 2008

wow...that is wonderful...i hope its the same for me!!! what did you have to do to get the 5 year history? just go to your pcp dr and gyno? I know i have five years documented by my dr!!

I had to get my records from my PCP and my OB/GYN. I went in on 7/3 for the diagnostic and they did bloodwork, ekg, etc. I was submitted to insurace on 7/11 and got approval on 7/21. I have a tenative date of 8/1 scheduled but I do not think we will make it as I still have not done my pre-op tests. :thumbup:

But good luck to you!:crying:

Boopie · August 21, 2008

What if you have Kaiser and will now be changing to UHC, and you have the history from Kaiser and not United Heath Care. How does that work, do they need the history from them or can they use your prexisting history from Kaiser. I sure hope I dont have to start from scratch.

Melisa1 · August 21, 2008

Good question...im glad you are switching to UHC....ive heard horror stories about kaiser. You should be able to just get your history and submitt it to UHC. Im sure this happens all the time.

HappyCamper · August 22, 2008

What if you have Kaiser and will now be changing to UHC, and you have the history from Kaiser and not United Heath Care. How does that work, do they need the history from them or can they use your prexisting history from Kaiser. I sure hope I dont have to start from scratch.

I had Kaiser, then switched to UHC. My surgeons office told me I needed the 5 year history, but Kaiser lost my records. While I was trying to deal with Kaiser, I got a letter from UHC saying I was approved. Turns out I didn't need anything but a BMI over 40 or BMI over 35 with co-morbidities.

Boopie · August 22, 2008

HappyCamper And Melisa1, Thank you so much for your responses they were helpful. Im fairly new and I have not started my procedure yet. Im sifting through the paperwork that is needed to find out If UHC will cover through my employer (AT&T) in So. Cali. Then the ball will be rolling.:wink2:

KingsFan · August 24, 2008

I work for AT&T in SoCal too. I am scheduled for surgery on Sept. 12 at Cedars Sinai. So far UHC has covered the pre-op tests and the dietician and social worker visits. My doctor's office is confident that they will approve the surgery as well (although they can take a long time). I'll post when I get the insurance approval. Good luck!