United Healthcare ( backed my medicaid) and Prior Authorization
I have United Healthcare Community of Ohio (backed by medicaid) and the only thing that the insurance company can tell me is that I need a prior authorization. UHC could not tell me requirements or anything until I get word on the outcome of the prior authorization. After the prior authorization (if approved), I am guessing that I will find out what requirements I have to meet. I have an appointment for the WLP in Ashland for July. All I had to do on their end was get a referral from my doctor, which i did because I thought that was all I needed to do. I am glad that I did call my insurance company because prior authorizations can take up to like 7-10 days (sometimes longer). If I get the approval I will be good to go to start the journey BUT if I am denied, I cant. The good news to that would be that there is an appeal process if denied. It is better to know now than to start this process and get denied at the surgeon step. I am not sure why the WLP didnt tell me that I needed a prior authorization but I just went ahead and did that anyways. I am sick of not knowing. The anxiety is about to kill me. I am now at a stand still.. Hoping for good news soon!
So I got a call yesterday from my doctors office and they were trying to figure out what was going on with the prior authorization. They told me that when they called my insurance, UHC asked when my surgery date was. Apparently, that is what I need the prior authorization for. Which is not what I was told when I called UHC. I am honestly just confused. It isnt always as easy as calling your insurance company. I still have no idea of what requirements I will have to meet but I am just going to take this day by day and keep going forward.
I feel your pain girl! The SAME thing happened to me. For my Bariatric Surgery Application, I NEEDED all of their requirements before they would even schedule me for an initial consult. So I called UHC three times and each time they told me they cant tell me because it needs authorized and my doctor would need to call. So the bariatric department wouldn't make an appointment with me because I didn't have the information, and the insurance wouldn't give me the information because I didn't have the surgeon calling in. Finally I made an appointment with my PCP and she was confused too. She didn't understand why she would need to call them, especially if the prior authorization would come from a surgeon and not her anyway. So she said they aren't going to make this easy and keep pushing them. So I called two more times and finally got answers! I got my paperwork filled out to submit to the bariatric department! Basically what they told me what that they have no restrictions or specifications about BMI, diet and exercise history or anything at all. Basically just need a surgeon stating that it is medically necessary and then they can submit for pre authorization. I was told everything would be covered 100%. I hope this helps! Let me know if you have any other questions! :)
-Mandy Leigh :)
I am so happy that you responded. It does give me more hope. I have called UHC to try to figure out what the requirements are and the only thing that they can tell me is that is is covered if its deemed medically necessary. I am afraid that for that reason alone I will not be approved. I only have a high BMI of 44. I have no comorbities. I do have PCOS but it can not be used. My PCP referred me to the weight loss program and I started going through all of the steps. I have even met with the surgeon. The only things I have left to do is 3 classes and upper endoscope. They do not want to submit that info for approval until I have completed all the steps on their end. The lady seems to think that they may require a 6 month diet so I have started that with my PCP and my first weigh in is the 29th. My last class is in November and they she said they are going to submit everything in October. I am just scared because I dont have any clear answers and the weight loss program has no information we are just kindly going by the seat of our pants.
Do you think we are waiting for nothing? How far have you gotten in you program? Have you been approved for surgery? Where are you from? I am sorry for all the questions but you are the first person to respond with any kind of knowledge. Thank you so much!
How long did it take to be approved? I have the same plan. And I have completed everything. I won't be submitted until Monday bc RN is on vacation. I'm a little frustrated bc I should have already been submitted but they didnt call to asked me about the sleep study they just assumed I didn't do it and put me to the side. Now I have longer ton wait. Also after approval when how long til surgery?
