Insurance approval

Rtarver2006
on 1/23/18 5:30 pm - Zachary, La

I have a consultation at a bariatric surgeon on march 1st. I know it sometimes takes a while to get approval from insurance. But i was wondering if any of you have united healthcare community plan and about how long it took to get approval from them. Thanks in advance.

DonRobbie
on 1/23/18 7:36 pm
DS on 12/18/18

Coverage varies by employer as well as by insurance company (employers can save money by opting to exclude Weight Loss Surgery from their policy). I have UHC but my employer does not cover WLS. My understanding from my research is that UHC requires a 6 month medically supervised diet for approval. They also have an affiliated company (Optum) that you might be referred to.

Oxford Comma Hag
on 1/24/18 5:22 am

Community Plan is not employer sponsored. It is Medicaid.

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Lyds85
on 1/23/18 7:47 pm
RNY on 02/20/18

Trying calling the insurance directly. They should be able to give you information about what your coverage is.

Oxford Comma Hag
on 1/24/18 5:20 am

With all needed documentation, I usually see a decision from UHC in less than a week if criteria is met.

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Rtarver2006
on 1/24/18 9:12 am - Zachary, La

Thank you so much ?

artchikk
on 1/24/18 1:34 pm
RNY on 02/12/18

most insurance plans that cover bariatric surgery do require a 6 months documented physician directed diet program. I had a friend who was approved for RNY with medicaid several years ago and she still had to do the 6 month diet.
I have a UHC plan through my husband's employer and the guidelines were pretty loose about this, they said that the 6 visits could have taken place any time within the last 5 years as long as they were documented by a physician, and could be from a variety of different types of doctors (PCP, Endocrinologist, OBGYN, dietician, etc). they just sent me a form for my providers to sign with the dates of the visits and documented weight loss discussion and my current weight at the time and then I sent the form to my Surgeons office and they submitted it to my insurance plan for pre-cert.
They also wanted me to have a psych eval and a letter of recommendation from another provider (other than my surgeon) stating they recommended the surgery. I just had to call the number on their website to enroll in the bariatric program and they set up a call with a nurse to go over all the requirements with me.

other than that, I believe you just need to meet medical guidelines, like a BMI over 40 or BMI over 35 with one or more comorbidities (diabetes, HTN, heart disease, sleep apnea, etc) and then anything your surgeon recommends or required. luckily my surgeon is part of a large group that specializes in bariatric surgeries and they basically have everything organized there for you- a lot of groups will look into your benefits for you and let you know exactly what you need to be approved and a lot of them will even help you set up all the appointments and give you referrals.
I had to see a dietician and go to a dietary class, I needed to see a pumonologist and be tested for sleep apnea, I had a psych eval and had to attend a seminar on behavioral modifications post-op and I need to have an upper GI endoscopy.
I had enough doctor visits in the last few years to count toward my 6 months but getting all the other appointments and requirements completed took some finagling--especially if you need to take time off work but if you're driven and organized, you can probably get it all done rather quickly.
I saw my surgeon for a consult back in November 2017 but decided to wait til after 1/1 to get all my other appointments out of the way so it went onto my 2018 deductible.
I actually got it all done in a matter of like 3 weeks because I was approved and scheduled for surgery by last week. my surgery date is scheduled for 2/12.
Once you have all the requirements met, your insurance usually won't take longer than a few days to actually send an approval.

Liz WantsHealthForAll
on 1/25/18 9:19 am - Cape Cod, MA
VSG on 03/28/16

I also had UHC through my employer and my requirements/experience was like Artchikk's. Final approval was possibly 2 weeks? I had an assigned case manager through Optimum and she checked to make sure all paperwork submitted was received and called to tell me about the approval. I called my surgeon, they checked and said yes they had the approval. My surgery was 10 days later.

Liz 5'3" HW: 219 SW: 185 GW: 125 LW: 113 Desired maintenance range: 120-123 CW: 120 (after losing 20 lb. regain)!

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