State Employee UHC criteria for Revision

I am wondering if anyone has been successful in getting approved for a revision.  Also, if you have been able to get the criteria out of UHC I would like to know what they are.  I know we have an exclusion unless medically appropriate, I am looking for hints to get approved.  Any help would be appreciated.

Does UHC of Tucson have the policy on line? I find mine out by accident. I printed the whole 45 pages and gave it Mikki at Dr Schlesinger office. I have Healthnet HMO Ruby Plan 2. You  need to read over the revision part like I did and I already meet the guidelines. So said it would be great if all patients would have a copy of their Bariatric Policy. I also had tons of medical records. She said I have made her job easier. I also gave her about 20 business cards of all the doctors that I go to and also the past doctors. 

Hi Dawn, It's not simple.  I have the insurance booklet.  It says it's excluded unless medically appropriate.  I will talk to Mikki when I can today and will fax her a copy of the pages.  I was trying to find out if anyone else gotten approved.  I told Dr. Schlesinger that I will hire a lawyer if need be to get this approved.  It won't be the first time that I hired him.  It was the best $ that I spent to get my first surgery.  UHC won't give me that information as I have tried to get it already.  They may give it to Dr. Schlesinger's office.   We may have to just submit it and see what happens.

There is a accutal policy for UHC and they need to fax it to you, email or mail it to you. My policy is a whole 45 pages long. I can email it to you to get a ideaa about federal guidelines. Dawn   

Hi Dawn, I have UHC-EPO for state employees.  I got the Plan Description booklet that is 128 pages.  It doesn't give specifics which is what I am looking for.  It's the criteria that they use to approve/deny it that I am looking for.  Sometimes it comes out with a denial letter.  If you have specific information, PM me with the info and I will send you my real email address.

Deanne, Tell them you want the actual criteria for revision's. They have to give it to you. If they don't call The state of AZ insurance people. I have their phone nummber but I have to look for it if you want it. Its no problem. My criteria for my insurance is all on line. Dawn

Is your UHC a HMO or PPO. I know Sr Schlesinger only takes Healthnet HMO. Mikki said HMO's pay less Than PPO or PFFS. She said that they take alot of insurance. I was lucky she said. I will make sure I will switch to a PPO next year because DR S may say were not taking Healthnet HMO any more. I would Mikki in the AM or ask DJ what insurance if you knows what they take. Dawn 

Deanne, Are you going to be at the Vitalady event?  Nita & I are planning on coming together & if I remember correctly, she has UHC through the State of AZ.  She is still fighting with them to have the revision approved but she has had some good news in the past few days.  Unfortunately, she had to go out of town and won't be bac****il Thursday.   If you (or she) are not able to be at the Vitalady reception, send me an email and we'll get you on our westside yahoo group so you & Nita can talk.  I know she would be happy to help you deal with UHC. Later! Dj

DJ, I won't be able to come unfortunately.  I would have liked too.   I am trying to get the criteria for Dr. Schlesinger, so we know exactly what we need to do to get approved.  I would love to get any information that I can from Nita.   It was good seeing you on Saturday! Deanne