Question:
Can anyone tell me what UNITED HEALTHCARE PPO requires?
We have new insurance beginning May 1st and I'm hoping beyond hope that they will approve my surgery. Will it be considered pre-existing if I am already scheduled for June 3rd? I've been self-pay up to now, so I am excited to hear from anyone with information! Thanks so much--hope everyone is having a wonderful evening, Suzi — sm S. (posted on April 13, 2003)
April 13, 2003
Suzi, I had UHC/PPO and the only thing they required was to be 100 pounds
overweight and for it to be medically necessary. However some employer's
put in an exclusion. I also don't know how the pre-existing works. I wish
you the best of luck.
— Cookie G.
April 13, 2003
Each company's UHC ppo policy is different. When I had my surgery, it was
approved with no problem, just requiring a bmi of over 40. This year our
policy changed and now you are required to have an 18 month doctor
supervised diet. Sorry I can't give a pat answer. You will have to either
call them or read your new policy when you get it.
— joeandteri
April 13, 2003
I forgot to mention that UHC doesn't consider it a pre-existing condition.
— joeandteri
April 13, 2003
I have UHC, I haven't sent the request through yet but they are one of the
easier ones so I have heard....they say they usually approve quickly as
long as it is medically neccisary!
— Saxbyd
April 14, 2003
I have UHC EPO and will be applying in May (after my psy eval)...I called
them and they said all that's required is the its medically
nessessary...ie...the surgeon writes a letter saying why you need it. From
what I've heard, they approve in like 2-6 weeks. What state are you in?
— Renee B.
April 14, 2003
Suzi,
I am currently awaiting approval from UHC/PPO. I would recommend calling
the customer service number and finding out what needs to happen for
qualification. I would also get the number from Care coordination and
medical review. I have called UHC several times and unfortunately get
different answers every time. I have a bmi under 40 (39) and no
life-threatening co-morbids but enough that alter my lifestyle. They also
have a website myuhc.com where you can view their medical policies after
you register. While this doesn't ensure approval, it gives you an idea of
what they are looking for. From what I have heard, they are proactive and
wls friendly. Gopod luck and I hope this helps some.
— laura J.
April 14, 2003
If there's one thing I've learned while visiting this site, it's that every
policy is different. Call UHC's customer service department and inquiry
specifically about what's required for approval.
— Leni M.
April 14, 2003
I have UHC/PPO Tennesse. I was told pre existing is if you've been treated
in the past 6 mos for it. I realy didn't have a lot of problems getting
approved though. I had my pcp write a letter of support, I documented all
my dieting ( You need to have had at least 1 supervised diet in the last 18
mos),a psych consult, and they told me I had to have at least 2 co-moribds.
I have 3. I turend in my paperwork on march 12, called the office on march
15, and got approved on the 20th. I go in for mine in 11 days. They may or
may not consider it pre existing, but if they do, you can push the date up
by 6 mos from getting UHC, and they should cover you. Good luck, and God
Bless!
— mellyhudel
April 14, 2003
Suzi, when I went to have my surgery I called UHC. They had 7 requirements
that had to be fulfilled. They were you have to use an in network dr., 1
year of documentation of attempted weight loss failure from non-surgical
procedures,Obese at least 3 years,100 pounds overweight and a bmi of 40 or
more,Age20-55,no major psych. problems,no alcohol abuse within the last
year. This is what my plan called for. Hope it helps.Although, I was
approved rather quickly once my Dr. sent in his letter with all this plus
his letter of request. Lynne Kinnison
— Lynne K.
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