United Health Care

hi everyone! I am new to this board but not at all new to this subject. I have been trying to get GBS RNY done since November 2001. I have gone through 3 different insurance companies and the first two, Cigna and Mayo didn't seem to think I qualified. Got denied, even with appeals. Not enough wrong with me. Now its been 2 1/2 years, I'm 45 pounds heavier and worsened sleep apnea (twice as bad as it was), add the chronic back pain and bmi increased by 4 points....I think I am more than qualified...sooo....I am trying a third insurance company now and have been very encouraged by UHC. I have choice plus pos plan and work for america west airlines. They have told me the several times I have called that it is an exclusion so it needs a "predetermination" and must be medically necessary. However they don't seem to have the specifics as to what they feel meets that criteria. Mayo had the same thing but I didn't have any of the four things they listed, wrong with me ( i don't have diabetes, high blood pressure, high cholesterol or a bad liver....that's what they required). I do have severe sleep apnea among several other things. I have gone onto myuhc.com which is what they told me to do for more research and I believe that they DO consider severe sleep apnea a medical reason. I just got another sleep test done (first in two years) and they are doubling the level of my cpap. It has definately gotten worse. I am praying so hard that this is approved. I am now in the waiting process. Going through Dr. Zahn, whom I love. Nicole sent my info into them on the 11th of May, said it takes about a month to get to a nurse for review and decision and she ( the nurse) will call if she needs anything else. So I am trying to use my time getting everything ready that they may need. Just in case... But, has anyone out there experienced UHC?? I have gotten an email from one poster and she was very encouraging. I also got into the insurance section but wanted to hear first hand any experiences.... Thanks so much for letting me rant...any help and prayers are welcomed and appreciated. thanks, shannon

Hi Shannon, I also have United Health Care and went through Dr. Zahn. I was accepted 13 days after seeing Dr. Zahn. I had gotten my letter first through UHC and then Nicole called me up a couple of weeks later. It only took her that long to call me because they were having some things going on in the office that prevented her from doing it sooner. Granted, once I was approved I had 4 1/2 months to wait for surgery. Now it's less than 2 months away so it does go by quickly. Best of luck on getting your approval!!!! Debbie Cortez

Cool! Nicole is great! I hope mine is that fast! I know the wait for the surgery date is pretty long. but it's worth it to have Dr. Zahn! I can handle waiting as long as I know that I'm approved. That is he news I am having a hard time waiting for! Which plan did you have? Did they have an exclusion for you? What co-morbities do you have, if you don't mind me asking.... shannon

I think that Nicole is great too. Others don't seem to have that same feeling though...lol. It's definitely nerve wracking waiting to hear if you've been accepted or not. I know that when I was I started bawling like a baby because I was so excited. I had been turned down before because I had tried going to the Bariactric Treatment Center, but none of their doctors were on my plan. As far as my insurance plan goes, I have a PPO through my husband work. The only exclusion on it was that I had to be considered morbidly obese. It's great that I was accepted but boy is it terrible to be considered that. I have sleep apnea and get extremely swollen ankles, feet and legs. The swollen part isn't overly bad, but I know that it's not good for especially your ankles. I haven't slept a full night with my husband in probably four years because of my sleep apnea. I snore so loud that my kids can hear it down the hall with my bedroom door closed! God help the person I room with afterwards...lol. If you'd like, Shannon, you can e-mail me at [email protected] if you'd like to talk more about it or would just like to have a friend to go through this with. I've "met" two people through this website. One has met her goal weight and the other one is scheduled for surgery later this year and they have both been wonderful. It's just easier, I think, to talk about this with someone who fully understands what you're going through. My husband has been amazing throughout all this, but he can't completely understand what it's like and this site is perfect for people like us. Take care and hope to hear from you soon. *HUGS* Debbie

I don't know if I'm the person *****plied to you before, but here goes. My husband works for AWA also. I started to do this back when we had Cigna and as the story goes things changed Jan 1. I had no problem at all. Unless the plan has changed it is not a plan exlcusion. It is a covered benefit based on medical necessity. I had my surgery 1 Apr with Dr. Newhoff and all my bills have been processed or paid. Once you have selected your surgeon have them submit all your history for predetermination (which is just another word for authorization) . My surgeon's office did all the paper work for me. I did call once a week after I found out the date they sent for the authorization. Call the customer service line and wait for the prompts to get to the predetermination dept which are all nurses and ask if there is any updates on the request. Mine was sent in 9 Jan approved 24 Feb and surgery was 1 Apr and that's only because I was slow on getting my pysch eval done. I actually found out on the phone before the surgeon's office. Good luck!

Oh my gosh ! You are awsome! Debbie, I would love to email you on a regular basis. I need a "buddy" for support. I am a single mom of a nine year old daughter and she is supportive and so is my mom but it's just not the same. you know what I mean! I will write more later in email paula - you weren't the one i had spoken to perviously but boy was I excited you replied. I was hoping someone had UHC thru AWA. I know plans can differ with each employer and that really has encouraged me! They mentioned predetermination to me also. It was sent in on 11May. I called last thursday and said they didn't have it yet but he told me that doesn't mean it wasn't sent, I know Nicole has a tracking number and they told me the cust serv people at UHC don't talk between departments so they would say that, so that doesn't worry me. Anyway, that pretty much matches what I have been told. I called them when we were going through open enrollment back in Oct/Nov. 2003 and they told me just what you did. but I thought they had mentioned it was an exclusion. The first girl was more specific than the other two people I have spoken with were. What department does your husband work for? I am in operations in System Operation Control at the Flight Center. AWA has lots of people but just curious where he works. Thanks so much both of you and if you can remember anything else that may be helpful, please let me know. I will talk to you both soon! P.S. Paula - how much weight have you lost? That's not a bad time frame...I went to Dr. Zahn's seminar in November of 2003, consultation wasn't until 5/10, then I put off the psych eval so that was the same wek as the consult. then like Debbie said, I expect to wait about 4 months. I am actually hoping for November, then I can have the holidays off!!! LOL

Hi Shannon....I work for AWA and know exactly what you're reffering to with the insurance. I went with Dr.Simon with UHC and just had my surgery 2 weeks ago. I did the whole song and dance with Mayo and was declined...as is every other person I've talked to at AWA that tried through them. However, I went for my consultation with Dr.Simon at the beginning of March and 2 months later....I'm on the losing side. I have told a few people in revenue accounting where I work and another girl has a surgery date for next month. It has been night and day different this time around! They approved me within a week....I was blown away. Good luck to you!! Nicola

Nicola, That is great! Maybe I should have gone to a different surgeon and it wouldn't have taken so long....Oh well.....I like Dr. Zahn, it just takes forever. I guess if I have waited this long, I can wait a few mor months... Mayo - it was just absolutely horrible....I am sure you know taht whole drill....seeing and endochronologist first, not allowing you to see the surgeon, then having to go through so many tests and probes just to prove any type of medical necessity....to get denied flat out......then for them to blame AWA after my appeal....whatever....I had met one lady in the info seminar for Dr. Swain that worked for AWA who got approved...don't aske me how she got it....but she was not very nice when I asked her about it.... I am so glad you let me know about you girls in Rev. Accounting. I am over at the flight center in SOC, as a Crew Coordinator. I work with a girl named Ginny Canning who came over from your area a couple of years ago, do you know her???? She's really nice... Anyhooo, I am feeling more and more encouraged everyday! Did you take the full 6 months off of work. I am planning on taking as much time as medically allowed, to take advantage of it. I will keep you posted as to the news I get from UHC. BTW, Which plan do you have with them? I told the HR lady when I was going thru open enrollment what I wanted to do with the surgery and she told me to go with the platinum plan, the most expensive one....It's worth the extra money every month. Just curious if you went the same route. I think it's called "choice plus" when I go onto myuhc.com.....I know they payed for Dr. Zahn's consult right away....no problems there, and I know he was in-network..... Can I ask you a personal question....what were your co-morbities and bmi??? I am trying to find out how they consider medical necessity. Like I told Paula in an email, I think I am so jaded from my experience with mayo that I automatically think I am going to get screwed, even when I am hearing so many good things about UHC and the surgery. But if I know what others medical history was like that got approved, it would help settle my nerves.. thanks and hope to hear back from you soon! you can also email me at work: [email protected]

ok, so I called the UHC cust serv number and went to the proper area for pre-determination as I was instructed.....They said it is in the nurse's hands!! So it could be anytime now that I get a decision!!! I have been told it only takes a day or two for them to decide once the nurse has it!! yeah!!! hopeful, shannon

My fingers and toes and anything else I can cross are crossed for ya. My prayers are right along side of them. I know that it is so frustrating to wait and wait. I have a good feeling about this. Take care and let us know what is going on!!!! Tammy Lap RNY 1/8/04 326/240/125