United Healthcare

Can anyone provide any insight to me as far as what United Healthcare uses as their guideline for approving WLS? I tried to find out tonight by calling but all they could say was "subject to medical review guidelines". I have a BMI around 42-43 which is morbidly obese as well as a couple comorbidities (high blood pressure, gerd, some joint and back issues.) and adverse family history for heart disease and diabeties. The reason I ask is because while I've tried and failed at many diets (Atkins, South Beach, etc.), weigh****chers, nutrisystem, etc. I don't have any documentation of these. I also haven't been on any medically supervised plan because my PCP's response to weight questions is "eat less and go jogging". [Actually I did quite well at Atkins until I put the weight right back on and then some] Thanks

Do you have UHC alone or does it come under the Empire plan umbrella. I had the latter, where UHC paid for my surgeon's appts, cardio, pulmonary and endocrinologist appts, then everything was submitted to BC/BS ( also under the umbrella) for the approval. BC/BS pays all hospital costs. My surgeon was out-of-network for UHC, so they pay what they deem to be average costs. Hope this helps.

Hi Dawn, Thanks for your reply! I don't know what the Empire plan is so I guess not. I have United Healthcare EPO currently. My work offers EPO and PPO for UHC, I can switch every November. They told me WLS is covered "subject to medical review guidelines" but couldn't offer any details on how they guideline it.

Hi there I have United Healthcare...Choice Plus....and they were great as far as getting approval....I got approved in 2 days....It did need to be medically necessary and my particular plan did cover it if it was deemed medically necessary, but I had to submit prior weight loss attempts per my surgeon because it did help attain approval..I had tried W.W. more than I can remember and had saved my most recent W.W. weigh in booklets where I lost almost 60 #. I think those docs are what helped seal this approval... From what I have been hearing, insurance companies are going to make it much harder for us to gain approval without a supervised diet....but so far to my knowledge...United Healthcare remains fine....Good luck and stay positive!!!! Cathy surgery 48 hours away...yikes

I didn't save any WW materials. My attempt was a while ago with WW. Good luck with your surgury.

Hi again: When they say meet medical guidelines...they mean that your BMI must be higher than 40 and your doc must agree that this surgery is right for you.....as long as you meet that criteria....that should suffice....I must've called UHC at least 20 times and got different information most of the time....Just keep calling and asking.....Good Luck

This is true. UHC's member care people aren't very consistent. I got varying information about whether I needed a referall for the dermatologist. I ended up calling 3 times.

er... referral ... i wish you could edit posts on this board . ;)

Hey Steve I have United Heathcare as well and my Surgeon gave me the list of Pre-op Dr's I need to see in order to fufill my insurance and Surgeons requirements. I would try to select a Surgeon first then direct this to them. My Dr told me that United is very good and pretty much supports this Surgery. However a PCP that makes a comment like that may not be to helpful to you when you need his recommendation letter. may want to consider seeing another Dr. for their opinion. Well Good Luck and welcome to AMOS Louis

Hi Stephen, I also have United Health Care and had no trouble at all getting approved for surgery. My PCP was all for it, my surgeon is a participating member (always helpful) and felt that I was an excellent candidate, and the other specialists I had to see also felt that wls would be beneficial to my health. My BMI is around 43, I have a really bad back, arthritis in my hips, and some other weight related problems. When I saw my surgeon, he asked about other diets and I told him the ones I had tried and failed at, but he didn't need any kind of medical documentation to prove that. Once the insurance company was petitioned for the surgery I had an answer within 3 days. I would say that if your PCP isn't really on board with you having this surgery you might want to ask why and if he/she can't be swayed, perhaps you should find another doctor (at least for this). Your PCP's reccommendation weighs heavily in the decision making process. I wish you all the best and hope that you have a successful journey! Hugs, Lisa