I am SOOOOOOO frustrated with just trying to get started with WLS.  UHC HRA insurance through state health benefit plan requires you to call their Optimum Health Bariatric Resources to register with their bariatric program, see if you are eligible for the program, and if so, to be assigned a case manager.  I've been calling since the MINUTE my 2010 insurance went into effect and cannot get anyone to call me back.  Until I get accepted and have a case manager, I cannot do anything to get started on whatever insurance requires of me before I can have WLS.  This is really, really frustrating.  I don't want to be rude to the UHC operator, but I did let her know that I had been leaving my phone number with them since Monday.  She says they are busy because it is the first of the year.  I can understand that....TO A POINT.  It just unnerves me when I am paying mega $ for insurance coverage and cannot get the SERVICE that one would expect.  One of the moments when I just HAD to vent..................thanks for listening.............

I have Cgna HRA through the State and it took me three phone calls to have a case manager assigned to me today.  She said that someone should call me back either tomorrow or by Monday.  I'll cross my fingers.  When i realized that I had to wait for my insurance to change over, I started the support groups and met with my PCP to start my supervised diet.  So when it finally kicked in, I have three months of both done, and I had a sleep study and was diagnosed with sleep apnea.  So I already had that under my belt.  So I only have until March to finish up with my diet and support groups.   I am about to set up my psych eval. to get that out of the way and I need to find out if I have to see a dietician.
If i were you, I would start what you can while you wait for UH.  You can attend a support group this month and meet with your PCP to start your supervised diet, if those are required for you.

Hello Andrea

I certainly understand your frustration.  I was once in your shoe and found myself feeling the exact same way. I had UHC as well, to keep you somewhat stress free, you should go ahead and set up and go for your first supervised doctors/pcp visit. I remember starting my PCP visit in November 2008 and my coverage did not start until January 2009. On that visit your doctor should be documenting your weight, diet, and exercise plan. At the end of each visit I recommend that you get a copy of what the doctor documented before leaving the office.  Do this on every visit, it just makes it easy for you, and you get to see if he or she is indeed documenting every thing that UHC require. You may also want to start attending support group  within your area, because If the requirements are like last year then you are gonna need 6 consecutive support group meeting.(On every support group that you attend, get the leader signature) The sooner you start the sooner you will be sitting on the loser bench. I'll be sure to save you a seat.

If you have any more question, please don't hesitate to pm me.

Izzy

Like Izzy said, go ahead and start your doctor appointments and attend a support group.  Those are the things that will take you 6 months.  It will be perfectly okay if you get a bariatric caseworker and are already in the process of getting things done. 

I hate to say this because it is so hard, but be patient.  I am assuming you are with SHBP.  This is year 2 that we have had the WLS benefit with our insurance coverage, and I know MANY that have switched just for this benefit.  

The rewards you will receive will far out weigh the wait time. 

Good luck and keep us posted on your progress!

All three of your posts have calmed me down some.  I do have an appointment in one week with my PCP....I had just hoped to have specific requirements from UHC before then so I don't end up with a wasted visit that UHC won't count towards their requirements.  

Thank you all for the pointers and for calming my nerves a bit.  The WLS coverage is the main reason I switched from UHC HMO to UHC HRA (yes, SHBP).  Unfortunately, I am already having problems with the prescription coverage under the HRA - - - - my son's medication that was $30 under HMO is $368 under HRA....and I have two sons that both take that medication.  I am thankful for the upfront $1500 HRA credit, but at $700 total a month for my sons meds, the credit will only get us through two months.  I hope the WLS coverage goes better than the RX coverage.

Thanks again!!!  This Board is such a wonderful wealth of information and support!

The one thing I can say is, once you hit your out of pocket maximum ($5700 for family including prescriptions, I think) you are done.  Also, once you hit your deductible, you will only have to pay 15% of the $700 for meds or anything else for that matter.  Those few months between maxing out the contribution and hitting the deductible might be tough.  Were you able to put any away in the flexible spending account? 

I haven't had any problems with UHC covering any of my appointments for pre op. 

If you have any other questions, let us know!

You have received some good advice already.  I agree, you should go ahead and schedule your supervised diet visits, and start support group sessions.  I, like Izzy started my pre-op requirements in November a couple of months before the coverage kicked in for 2009.  I have shbp Cigna HRA.

As far as the insurance woes, you are in for the fight of your life.  But,  the reward when you finally get that surgery date is worth every phone call and e-mail, and needle ***** you'll have to endure the next few months. 

One point to follow, is to document everything! Every phone call, e-mail, and letter you send.    Include the date, who you speak with, the time, and a summary of the conversation. Ask if they can e-mail you a confirmation of what they promise to do.  I  found sending communications by e-mail gives you an electronic paper trail.  

If you don't get anywhere by Monday, request you call be forwarded to a supervisor.  Unfortunately in customer service the squeaky wheel gets the grease, so squeak away.  You are fighting for your life and future, so being politely assertive may be necessary in the coming months.

If you have not done so already, invest in a simple 3 ringed binder and a few dividers.  This came in handy for me. I kept all my labs, test results, letters, call logs,  surgery research, weight logs, etc in my binder.  I kept it with me everywhere I went.  it often came in handy when I needed to fax a document to the surgeon and was away from home.  Sure I was a little compulsive about it, but it proved to be effective for me.


Best wishes in your progress. You have an advantage, since you are in the 2nd year group of shbp members to pursue wls. We veterans have done a lot of the roadwork for you.  Please keep us posted on how everything goes.  We are rooting for you!


~LaShelle




            

The Will To Win
(one the most classic motivational poems)

If you want a thing bad enough
To go out and fight for it,
Work day and night for it,
Give up your time and your peace and
your sleep for it

If only desire of it
Makes you quite mad enough
Never to tire of it,
Makes you hold all other things tawdry
and cheap for it

If life seems all empty and useless without it
And all that you scheme and you dream is about it,

If gladly you'll sweat for it,
Fret for it, Plan for it,
Lose all your terror of God or man for it,

If you'll simply go after that thing that you want.
With all your capacity,
Strength and sagacity,
Faith, hope and confidence, stern pertinacity,

If neither cold poverty, famished and gaunt,
Nor sickness nor pain
Of body or brain
Can turn you away from the thing that you want,

If dogged and grim you besiege and beset it,
You'll get it!

-- Berton Braley

            

                                                                          

Andrea,
Like everyone has said, you can go ahead and start the PCP 6 month weight loss and the support group/counseling sessions.  They must be six consecutive months so make sure you don't miss a month.
I had completed my six month weight loss program and only had to do the counseling sessions for six months..  Just make sure your PCP has everything you need in your record.  I used my diabetes classes/training/exercise program for mine and they allowed it. It was actually documented every week.
Once I got my bariatric nurse, I didn't have any problems.  You will also have another person with the counseling side that will keep up with that and coordinate with your nurse unless things have changed.
It usually took them 1 or 2 days to return my phone calls.
Good luck and keep us posted.
Linda

Thanks to all of you!  You're right about documenting every phone call and correspondence......I like the notebook idea and will get that organized ASAP.  Thanks for your unending support and advice!!!....you ALL are great!

I have SHBP UHC as well. It's a process, sigh. However, the nurse coordinator will end up telling you stuff that you know...So while you wait, get the requirements done. They are pretty straight forward 6 months of supervised visits to your PCP, 6 months of support groups and a Psych eval. It's wonderful that you already have a doctor's visit scheduled. My visits to my PCP were pretty painless...and the actual insurance requirements weren't that bad. Getting folks on the phone will drive you to drink!  You'll have moments of frustration throughout the process, I had moments where I cried, wanted to go on gun totin' rampage, etc. However, It was all worth it in the end. Hang in there girl...these frustrating moments will be a distant memory one day.