Question:
I was told by my dr's office I need to first be pre-determined to need the surgery

My Dr's office called UHC and they said that they now first pre-determine if you need or qualify for the surgery, then they have the dr's office submit medical codes for approval. Could someone please tell me what they look for? I am nervous now!    — Stephanie B. (posted on May 1, 2002)

May 1, 2002
I have UHC PPO and before I was able to have a surgical consult, my doctor's office called UHC for approval of the consult and to find out if they required a PCP referral. When I read your question, it reminded me of that process. With your BMI, I think you would qualify with no problem. I had BMI of 50 and no co-morbidities were diagnosed when UHC approved the consult and later approved the whole surgery! Good luck to you!
   — Heather H.

May 1, 2002
I think, if I understand what the question, is that the insurance co. wants a letter of medical necessity. This will state your height & weight, BMI and any co-morbidities that you have (hypertension, sleep apnea, disc disease, GERD, etc). Each insurance co. has their own criteria that you must meet before they will approve surgery. Hope this helps, if not, you can email me.
   — DJeffrey