UHC and support groups
I attended three different support groups in the south Atlanta area. UHC is trying to deny me for attending all three groups. Recently, UHC changed their requirements for support groups. Support group leaders must be RN or dietitians. Most of the groups in my area are led by post-op individuals. It seems like another barrier UHC is decided to use to stop individuals from having surgery. I just though I would let everyone know especially due to people inquiring about the best insurance for approval.
I believe my surgeon plans on submitting my paperwork and filing an appeal. Tiffany(Dr. Macik insurance person) says she will make some calls as well because it sounds ridiculous to her. I will finish most of my requirements in March. Support group can potentially hold up my surgery.
Stephanie
I believe my surgeon plans on submitting my paperwork and filing an appeal. Tiffany(Dr. Macik insurance person) says she will make some calls as well because it sounds ridiculous to her. I will finish most of my requirements in March. Support group can potentially hold up my surgery.
Stephanie
Oh man, well I am not sure if there is a time limit around that (like 6 meetings over six months), but if not, Dr Dennis Smith has 3 support groups a month and I "think" the woman who runs it might be a nurse.
Its in Marietta though, but I think they are having one tomorrow night. It might be worth investigating while Tifany is filing the appeal. Those things can sometimes take time. Just a thought. I hope everything works out for you girl and you get your surgery really soon. I TOTALLY understand setbacks and appeals.
Its in Marietta though, but I think they are having one tomorrow night. It might be worth investigating while Tifany is filing the appeal. Those things can sometimes take time. Just a thought. I hope everything works out for you girl and you get your surgery really soon. I TOTALLY understand setbacks and appeals.
Stephanie,
so sorry you are dealing with this. I was part of the first group of shbp wls patients in 2009 when it was first covered.
We went through all kinds of drama with uhc and cigna to get the rules straight and all the kinks worked out. Seems like they are moving backwards by making it harder on the newbies this year.
I want to let you know, we were successful in getting them to bend the rules and approve our surgeries. We did this by teaming up and not just settling for what they told us.
At the time GA forum was very active. There were tons of shbp posters every day. We communicated on here and all called and ambushed insurance reps and bit+hed and whined DAILY, sometimes several times a day. They knew many of us by name! LOL.
I don't know where those people are now? Seems like they used OH for support, got the wls and disappeared. It is a shame. I know Izzy and Curvybarbie had UHC and they did not go to a group on UHC's new list.
I am hoping some of the veteran UHC shbp people will chime in and let you know what they did to get their approvals.
And yes, this is a shbp issue and not a UHC issue. shbp has their own set of rules that DO differ from the regular rules. And, they are always NOT in the patient's favor.
so sorry you are dealing with this. I was part of the first group of shbp wls patients in 2009 when it was first covered.
We went through all kinds of drama with uhc and cigna to get the rules straight and all the kinks worked out. Seems like they are moving backwards by making it harder on the newbies this year.
I want to let you know, we were successful in getting them to bend the rules and approve our surgeries. We did this by teaming up and not just settling for what they told us.
At the time GA forum was very active. There were tons of shbp posters every day. We communicated on here and all called and ambushed insurance reps and bit+hed and whined DAILY, sometimes several times a day. They knew many of us by name! LOL.
I don't know where those people are now? Seems like they used OH for support, got the wls and disappeared. It is a shame. I know Izzy and Curvybarbie had UHC and they did not go to a group on UHC's new list.
I am hoping some of the veteran UHC shbp people will chime in and let you know what they did to get their approvals.
And yes, this is a shbp issue and not a UHC issue. shbp has their own set of rules that DO differ from the regular rules. And, they are always NOT in the patient's favor.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I 
MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
I was finally approved yesterday. I started this journey in May of 2010. I attended 3 support group meetings and then just went to the psychologist. It was only about ten dollars per visit and UHC accepts it if the psychologist says it is ok. I thought I would be ready in January, but they came back and said that the visits had to be a month apart. You can not skip a month and double up in a month later. I am so glad I have finally finished jumping through those hoops and can go on with my surgery. I have it set for March 31st. They could do it as early as next week, but I teach and wanted to use my Spring Break as recovery instead of losing the days and being away from my students that long.
Good luck and best wishes!!!!!!!!!!1
Good luck and best wishes!!!!!!!!!!1
Lori
RNY ~ 3/31/11
RNY ~ 3/31/11
Stephanie,
Thanks for the information. I just started the process through UHC (SHBP also) and I was NEVER told that the group leader had to be an RN or dietician (the form does ask for the leader's credentials, but doesn't say anywhere what credentials are required). Neither the RN case manager nor the SHBP patient advocate mentioned that the leader has to have certain credentials.
Thankfully, the leader of the first group I attended is an RN; I guess I'll continue going to that group each month (even though there is one only 2 miles away from my house - I'm not taking any chances).
I really am sorry that they are just springing this on you now. I have had so many problems with UHC (outside of looking into WLS) in the past year - one of my providers has encouraged me to go to my benefits department and complain as the Dept of Community Health will be putting the contracts up for insurance companies soon.
Good luck,
Cathy
Thanks for the information. I just started the process through UHC (SHBP also) and I was NEVER told that the group leader had to be an RN or dietician (the form does ask for the leader's credentials, but doesn't say anywhere what credentials are required). Neither the RN case manager nor the SHBP patient advocate mentioned that the leader has to have certain credentials.
Thankfully, the leader of the first group I attended is an RN; I guess I'll continue going to that group each month (even though there is one only 2 miles away from my house - I'm not taking any chances).
I really am sorry that they are just springing this on you now. I have had so many problems with UHC (outside of looking into WLS) in the past year - one of my providers has encouraged me to go to my benefits department and complain as the Dept of Community Health will be putting the contracts up for insurance companies soon.
Good luck,
Cathy
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