Does anyone have the shbp requirements and surgeon list for UHC?

I posted the info for Cigna. If anyone has the info for UHC pease share, so pre-ops can evaluate it before they choose their insurance during open enrollment.

Remember how much help we were for each other?   It's time to play it forward.

Bariatric Resource Services (BRS)       For members requesting Lap Band maintenance procedures please advise that this is covered under the medical benefit and does not follow BRS guidelines.

SHBP will provide an obesity surgery benefit beginning 1/1/09 for the HRA and HDHP plans only (and only applies when SHBP coverage is primary). It is not covered for the PPO and HMO. All authorization information and enrollment for bariatric surgery must be initiated through OptumHealth’s Bariatric Resource Services. Covered participants seeking coverage for bariatric surgery should notify Bariatric Resource Services when the program and benefit becomes effective.   Customer Care may transfer the caller to Bariatric Resource Services to speak with a bariatric nurse consultant.   Bariatric Resource Services is a program administered by UnitedHealthcare and its affiliates. For obesity surgery services to be considered Covered Health Services under the BRS program, you must contact Bariatric Resource Services and speak with a nurse consultant prior to receiving services. Bariatric Resource Services will be available for these discussions after 1/1/2009.   Specific Benefit Design and Limitations   ·        One procedure per lifetime ·        Applies to Active and Retirees ·        Members and dependents over the age of 18 and physically mature ·        Deductibles and Out of pocket expenses apply to all services associated with the procedure   Pre-Surgical Requirements   You must meet all of the requirements below BEFORE the benefit is approved.  You must contact Bariatric Resource Services and speak with a nurse consultant prior to beginning pre-surgical requirements:    Ø      You have a minimum Body Mass Index (BMI) of 40, or 35 with at least 2 co-morbid conditions Ø      You are over the age of 18 and physically mature Ø      Weight reduction services are covered ONLY after you contact UHC's BRS program and receive PRIOR approval. Weight reduction services are covered only at approved BRS COE and by an approved BRS COE surgeon who is approved by the BRS COE program. Ø      You must complete the myuhc.com health risk assessment Ø      You must successfully complete a six month physician supervised weight loss program Ø      You must successfully complete pre-surgical psychological evaluation and outpatient counseling (or support groups) for six months Ø      You must agree to comply with all post-surgical program follow-ups as suggested by the Bariatric Resource Services nurse consultant (post-surgical nutritional counseling, post-surgical outpatient behavioral counseling)   If the caller needs additional information on the program and clinical requirements, the Customer Care Professional can send a message via the PEACH mailbox, including the caller’s call back information, and the caller can expect a return call.   They can access the BRS Service Centers of Excellence Programs at 1-888-936-7246.

I'm not sure about the surgeons that are in network.  I believe they are the same as Cigna.

Thanks, the surgeons and hospitals are not all the same. Maybe someone will provide the list.  Do you have the info outlining the 6 mos diet, psych visits, support groups, etc?

The 6 month diet can be with a PCP or with the surgeons office.  It must state that it is a weight loss consultation and use the words diet and exercise in the write up.  You must go once a month for 6 consecutive months to get weighted.  The psychological evaluation needs to be done early in the process.  The psychologist will tell the case manager if you need one-on-one or group counseling or if you can just go to support groups.    Which one you do, counseling or support groups, you must go for 6 consecutive months.  The case manager will send a form that must be signed off by the support group leader. 

The important thing is to call UHC and get with a case manager.  The case manager is the there to help with any issue that comes up and to guide you on your way to an approval for surgery.