Question

I think I asked a similar quesiton like this before but didn't receive responses. My question.....I have United Healthcare through my husbands employer. I called them to see if Gastric Bybass is covered(I gave them the cpt code)... They said it is a covered benefit if it's deemed a medical necc.... O.K. I understand that.... I asked them if I need to have documentation of supervised weight loss and they said yes... I asked how long would I have to be under a "supervised weight loss" plan and she says she doesn't know. The surgeon would have to submit the paperwork for pre-determination and then go from there. Is that the correct procedure? I 'm confused because if I do the 6 month supervised and then they come back and say I need 3 months?...1 year?...5 years?......PLEASE HELP IF YOU KNOW THE ANSWER!! Thank you!

I too have UHC through my husbands work. I too called UHC to ask about the req's and they told me they didn't have them and to contact the employer. So my husband went to his HR department and got the req's. That is my advice to you. There are a lot of different kinds of plan through UHC and they can't know all the reqs so they don't even try. I had to have been 100 lbs over weight for 3 years, and have documented medical supervised weight loss attempts. It was very unclear and so I submitted what I could come up easily. They denied me I did some digging and got my OB/GYN to send all the records from 2001 (they they had already submitted) and he wrote me a letter. I also wrote a letter stating the things I had tried and a list of place like Jenny Craig and the gyms with all the addresses. Called Jenny Craig and got my paper work from them. Got approved on my appeal. My advice is to have EVERYTHING you can think of and them some and stick on UHC I had to re fax my requests 5 times and finally they had me fax it to a different number and they got it personally. Don't give up..Talk to HR at your hubby's work it should be outlined somewhere with them. GL let me know if you have any more questions. Rebecca

What I did was contact my surgeon's office...explain that I had decided to have WLS.  They had me fax them my insurance Card & complete a health history form and fax it also...  They then contacted the insurance company and got all of the requirements from them.  The surgeon's Insurance clerk then e-mailed me exactly what is needed. I found that the Surgeon's office has a bit more understanding of the process and they were able to get the info much quicker than I could.