Newbie with questions about United Healthcare EPO

Hi all -

I'm new here and I'm hoping to have WLS. I've researching it for some time now. I have United Healthcare EPO and my policy states the surgery must be medically necessary.  My BMI is about 41, I have hypertension, pcos, sleep apnea, diabetes, arthritis, high cholesterol, heart murmur and shortness of breath. 

Is there any advice you can give me on dealing with the insurance company to avoid a denial?

Thanks in advance,
Kim

Hi Kim,

I too have UHC PPO. You should qualify with the following: "BMI is about 41, I have hypertension, pcos, sleep apnea, diabetes, arthritis, high cholesterol, heart murmur and shortness of breath. "
You will need a letter from your PCP, cardiac clearance, pulmonary clearance and medical records dating back 5 years. Yout issues are medical necessaties. Obtain letters from your, PCP, cardiologist and pulmonologist if you can. If denied appeal. You should be fine...good luck!

Hi Kim,

I too have United Healthcare EPO, it took about a week to be approved after getting all my stuff together.  My first apt was 1/26 and I had surgery 3/24 so it didn't take long, just get everything they want.  I needed 5 years doctors history, a letter from my current doctor stating it was neccesary (his letter said " I think she is a good candidate and recommend her for sugery with Dr. Schwartz"), and a psych eval.  I have no comorbidities but had a bmi over 50.  The hardest part of the whole thing was getting info from my previous doc office as it was a company owned clinic and as I left the company my records went into document storage.  After waiting a while and not knowing what was going on I called and explained the situation and the woman went and got them out the next day. 

Anyway long story short, my surgeons office said that United health care was really good about approving and so you shouldn't have a problem! Good luck!

Marcie

Hi Kim, I also have UHC-EPO and they were great no fusses I was approved for my RNY within 5 days . I had all my documentation needed and office of Dr. Burpee took care of all the rest.


Diane