UNITED approval process for Bre

Hi Bre - your email bounced when I sent it this morning - it returned a response saying it had been disabled or discontinued. I decided to post my answer publicly in the hope that it helps someone else with the same question. I certainly DO NOT mind at all to get emails from WLS buddies. That's is why my email address is linked to my profile. Regarding United Health Care - they didn't give my very much information either. I decided to call them a couple times a week. The correct departmet to speak with is the Care Coordination Department. You have to wade through the customers service automated menu to find them, but if you select the option to notify of a hospitalization or surgery, you then can get to the menu you need. Then you have to select whether you are a doctor or the patient, then I think you get the selection for the care coordination department. A lot of my local WLS peeps who called the care coordination department would ask for the name of the rep (though they usually state it, as well) that first sounds competent or caring - sometimes after many phone calls. I never bothered because I only found one that was helpful and it was on my last phone call. They can't tell you very much - First of all, it took over a week to get my paperwork into their system. Then it was "in predeterminations" for the next 4 weeks! FOUR WEEKS! I thought I was going to explode. Then, on the fourth week, (I had been calling about twice a week on Tuesdays and Fridays) the lady I spoke with said it had been referred back to the surgeon's office for more clinical information. Then I freaked. I had submitted a TON of clinical information and couldn't fathom that they would need more - I actually thought they were about to deny me. So I called my surgeon's office, and this is the rundown that I got from them. Every insurance company has a very specific procedure and the surgeon's office has to follow it EXACTLY or the request is usually denied. I was then told that for United, the doctor is not allowed to send all the information in at the beginning. They have to send exactly what UHC asks for, and then UHC assigns a nurse to your case. When the nurse gets around to reviewing your information, they then ask your doctor to forward them more information. It's a waiting game. It makes me angry that this is the way things work, but this is the way it is. You have to play the game by their rules. Anyway, after expressing my concern that I would be waiting for another 5 weeks, the insurance coordinator at my surgeon's office told me that my diet history and clinical info looked good, and at this point (after the UHC nurse assigned to my case asks for more info) it usually takes only a few days to get a decision by UHC one way or the other. They had just faxed the information to UHC when I got in touch with them. I was approved the very next morning and given a surgery date. So I got impatient a little too early in the game. I hope this is a decent picture of the approval process from after the consultation with the surgeon takes place. Of course if someone had shared all this with me I probably would have been much more relaxed about the whole thing. Basically the speed of your approval depends on the nurse assigned to your case through care coordination. All that to say don't expect UHC to be super helpful. The girls in the care coordination department won't be able to tell you much beyond what stage of the process your request is in. They couldn't tell me what clinical info was requested or refer me to anyone else at UHC who could give me more information. I found the whole process very drawn out and frustrating, and I have a pretty good attitude. Don't lose hope and don't get discouraged too easily. I know a lady whose approval took over 18 months. It really sucked but she is glad that she got approved. United is pretty good and usually don't quibble about paying expenses, but they are SLOW. Take care - I hope this is the kind of info you were looking for.

Thanx Georgine. I just can't get anyone to tell if they even received the request from my doctor. Do you think I should be asking what stage of approval my request is in? I am really getting nothing outta this insurance people. They won't even talk to me. I am so lost in this process. I need help for people like you who have done this already.