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loggergal
on 3/30/13 5:45 am - Felton, PA
Topic: RE: UHC won?t give me my benefits and WLS requirements for 2012 - argh!

I had a similar problem with UHC when I looked into getting requirements from them back in July.  No one could answer how many months of nutritional classes I needed, or any other requirements nor could they refer me to any approved providers and I called several times and each time with a different person.  How is it that their representatives don't have the information you request?  Their representatives should have a cheat sheet on this stuff by now.  Any way, I went ahead with a program close to me because it seemed like most insurance companies require 6 months ($20/mo) plus copays for the specialist consults.  I completed everything, including all the consults and got the call today from a nurse at Optum Health Care who said I completed everything they require except for going through an "Optum" Bariatric Center of Excellence so they would have to DENY my claim but I could appeal.  

I knew the one in my local area said they were a Center of Excellence but I did not realize this is NOT a standard classification.  Each insurance company has their own set of standards apparently.  How was I to know that when UHC couldn't even tell me their requirements or even refer me to the 3rd party I was to apparently supposed to use?  UHC's plan through my husband's employer uses a third party, "Optum Health Care Bariatric Resources to verify and approve all their bariatric surgeries. I was in shock for them to deny me only because I didn't select a center of Excellence approved by them nor could they tell me if I could just go to an approved one without going through the whole process again.  They said that decision would be up to the surgeon.  REALLY!!??!! blush  Let me tell you, I cried and cried, screamed, cussed and screamed some more!!!  I have to fight my tears typing this now.  I have spent a lot of time, money, and effort to lose weight to only be told I didn't follow the proper steps but how can I prove that I was not given the proper information from UHC?  I only hope someone has the common sense to allow me to go through their Center of Excellence program without starting over the whole program and consults. I can't wait until Monday morning.  You know I will be on the phone on Monday morning with all involved.

 I will post what I find out for any of those who might be in the same position.  Please keep your fingers crossed.   I basically had to go through trial and error but I guess they want us to not be successful so they incur more costs!  That's all for now.  Sorry to vent so much. 

I hope you finally received the information you were looking for and are on the right path.  

lv_my_labs
on 3/26/13 1:16 pm
Topic: RE: Uhc revision questions

Hello can you update your experience since it has been a few months since this post?  I'm starting the same process. Thanks in advance!

VSG on 06/12/13
Topic: RE: **UHC and 5 Years of Proof...??????
I just contacted the medical records dept in each organization. Be sure to have records sent to you - then have your doc make copies. You retain the originals without having to pay your surgeon to get them should you ever need them back. This happened to me.

   

Sleeved 6/12/13 - 100 pounds lost to get to goal!

VSG on 06/12/13
Topic: RE: **UHC and 5 Years of Proof...??????
I also got records from urgent care. I am presently battling with UHC, so it remains to be seen if 5 years of being at a BMI higher than 40 is the same thing as an MO diagnosis., but every data point helps, right? Good luck!

   

Sleeved 6/12/13 - 100 pounds lost to get to goal!

bigfineazz
on 3/25/13 4:48 am - new orleans, LA
Topic: RE: **UHC and 5 Years of Proof...??????

thank you im going to see if this will work i was speaking to the surgeons nurse and she seems confident that everylittle biit will help so  next question i guess....how do i go about obtaining the medical records, just call and request or go to office and fill out paper work and submit paperwork fee?

noftessa0401
on 3/25/13 4:39 am - San Diego, CA
RNY on 12/27/12
Topic: RE: **UHC and 5 Years of Proof...??????

All but one year of weight records came from my gynecologist, and they were accepted by my insurance.  I just made sure to include weights that were only during times I was not pregnant.  I don't know if this would have mattered, but I thought I would ensure that, just in case.

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

bigfineazz
on 3/25/13 4:04 am - new orleans, LA
Topic: **UHC and 5 Years of Proof...??????

I was recently diagnosed with psuedotumor cerebrei after the birth of my 2nd daughter in september. i am 5'6' 250 lbs and have been stuggling with my weight for about 5 years. I however have not been going to a pcp about my weight problem. How would I provide documentation of my obesity? I did visit weight loss clinics, and contacted one for my records, would i ask my gynocologist for records of my weight also? That would really be the only doctor i appeared to have seen in the past few years.

Ashley H.
on 3/24/13 10:35 pm
RNY on 10/10/13
Topic: RE: I was approved!
Congratulations!! That has to rank as one of the happiest days of your life!! I can't wait for that call! I just started the process. Am hoping for surgery in October as my insurance company requires 6 months supervised diet. What were your requirements for approval?
Magooy29
on 3/24/13 8:56 am - WI
Topic: RE: anyone been approved by wal mart insurance for gastric bypass
Wls is a direct exclusion under walmart insurance, but due to life threatening things you have you can appeal that and then they HAVE to cover it. You have to get ahold of the person in charge of the insurance (ask your market human resource manager for that information) good luck and dont give up! It will be covered!
Magooy29
on 3/24/13 8:38 am - WI
Topic: I was approved!
On friday the 22nd of March I got a phone call telling me insurance approved the surgery!!! The best 30th birthday gift EVER! (Its my 30th birthday today). Now its time to wait for a date!!!
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