SHBP UHC HRA - anybody been through their WLS requirements?

My SHBP UHC insurance switches from HMO to HRA on Jan 1, 2010, which means I will have bariatric surgery coverage beginning Jan 1.  I have already attended Obesity Solutions information seminar and filled out the paperwork and am just waiting for Jan 1 to roll around so UHC will talk to me about insurance coverage and requirements.

Just wondering how strict the insurance requirements for WLS are under SHBP UHC HRA and would love to hear from anyone who has this exact plan and what they went through with insurance.  I am very excited about this venture, feel totally confident Obesity Solutions in Gainesville, GA.  My only reservations/concern is dealing with insurance.

I had surgery through UHC HRA last year.  I had to do six months of weight loss supervised by my Primary Care Physician(I actually got to use my Diabetes classes and follow up appointments) and also had to do six months of counseling or support group meetings.  I did the counseling.  It must be six consecutive months, if you miss a month, you start over.
You must use a Bariatric Center of Excellence approved by UHC.
I'm not sure if the guidelines will change next year or not.
Good luck.  Keep us posted on your progress.
Feel free to PM me if you have more questions.
Linda

Just as previous poster, I just had surgery through SHBP UHC HRA.  Here is what I had to do.  

1.  Call UHC.  I spoke to someone and they assigned me to a bariatric case worker.  Mine was Susan.  She returned my call within a few days of contacting UHC. Yours will give you names of surgeons and hospitals in your area that are on the Bariatric Center of Excellence.  your caseworker will also explain the following steps in detail.

2. Contact a psychologist or psychiatrist for a psych evaluation.  Upon review of the psych review, you can either go to counseling or group support meetings.  I went and still attend the support meetings at Emory Johns Creek.

3.Attend 6 months of counseling or support meetings.

4.  Attend 6 monthly visits with your doctor.   Each visit must CLEARLY state your weight and diet plan.   I used my endocrinologist.  Their notes forms for visits have specific places for this. 

The six months flew by once I got everything started.

Good luck and if you have any other concerns let us know!

I am so grateful for your responses.  Sounds like there is no way around the 6 months of supervised diet.  Do either of you know "why" the supervised diet is required???  I am perplexed as to why, if I have been unsuccessful at weight loss for 20 years, they would require this.  Also, what if you DO lose weight during the 6 months of supervised dieting???  Do they then consider you a success at dieting and deny insurance approval for WLS???

My doctor put me on the DASH diet (for weight loss and to lower blood pressure), but I did not have MONTHLY visits, so it sounds like this will not count towards the required 6 months.

Obesity Solutions is a center of excellence and has already confirmed that they have a contract with UHC, so I don't think I will have any problems in this area.

Thank you again for sharing your experience.  This forum has a wealth of information that only those that have been through WLS could provide!

You will only be considered as non qualifying if you lose enough weight to cause your BMI to drop below 40.  I went through the same steps as the listed in the previous posts and had no problems with approval.  My surgery was in November.  Research this site to help you select a doctor and hospital.  You will have to attend a seminar given by your surgeon before the surgeon's office will let you schedule an appointment.  I waited until the end of my 6 months to see the surgeon, took all of the required paperwork, and was approved with 2 weeks.

I was not successful with weight loss during my 6 months supervised diet and was still approved.

Good Luck

Just as previous poster said, UHC didn't care about the weight loss, just if you went to the Dr. once a month and weighed in.  The only thing that would change your surgery approval would be your BMI.  However, my surgeon did have a requirement that I not GAIN any weight between my initial consult appointment and my pre op appointment.  So check with your surgeon about his requirements.  My surgeon had a few additional ones as well like cardiac clearance, upper GI clearance and pulmonary clearance. 

Just keep in mind you need to follow insurance and surgeon requirements for this surgery. 

Good luck and keep us posted!

I went through the process as well (and two of my coworkers as well). The 6 months Drs visits are not optional unless something changes this year. I would go in talk to my nurse practitioner, and go home. It was painless, the group support meetings had a form for the leader to fill out and they were actually informative and helpful. You'll be assigned a Bariatric Coordinator and they will answer all and any questions you may have. The insurance part was well organized, and the painless part...they were specific and upfront w/ their requirements and approval was less than 24 hours after fulfilling those requirements! Good luck on your journey!

Thanks again for all of the good information!  You all have been very helpful.

Thanks for the info...I've been considering weight loss surgery for years. I will be 25 this year. I have a BMI of 51, and have struggled with weight since my adolescent years. I have done it all, as I'm sure you all have - weigh****chers, Atkins, South Beach, etc. I just want to finally get started and not put it off anymore.  I also have SHBP UHC HRA, and was worried they didn't cover it since I can't find anything on their website about it. I'm finally going to call them tomorrow!

I know that my plan has a $1100 deductible (first $500 is covered by a SHBP credit) and out of pocket maximum is $2500. I was wondering if anyone knew if there were any other expenses (other than co-pays after meeting the deductible)  that might be incurred for this?

Any info would be great, thanks.

Chris