Question:
Does anyone have United Healthcare and have to prove it to be med nec.?

My insurance denied verbally but said there was a claus if it could be proved medically necessary...has anyone gone through this and how long did it take and what all did they want???    — Marie B. (posted on June 29, 2001)

June 29, 2001
Marie, I have United Healthcare POS select, and I had no trouble at all with approval. When you say you were denied verbally, do you mean you called to see if WLS was covered, or your doctor submitted for approval? I called early on, and they tried to tell me it was normally something they didn't cover, but I knew better because a girl at work had already had surgery with the same insurance. I went to my first consultation, and the doc did the rest. I was approved within a couple of weeks with no problems at all. I really didn't have any comorbidited, but I did have a BMI of 69, and my doc laid it on a little thick with UHC, I think. I told him I had severe joint pain, back pain etc.... With your BMI I wouldn't think you should have a problem with approval. Good Luck. Feel free to e-mail me if you have any questions.
   — Kim B.

June 30, 2001
Hi Marie... I have UHC, Select Plus, POS. All you have to do to "prove" it medically necessary is have your PCP or OBGYN, or both write a letter stating that it is medically necessary. My PCP called my insurance to tell them that I needed surgery & it was medically necessary due to my BMI of 51 (no other comorbids). They approved it right then & there. If your PCP wont take time to write a letter, write one yourself & fax it to your doc and have your doc sign it. You really only need a paragraph or two. Good luck to you!!
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