UHC sucks

Before you even go to a seminar, get your insurance written policy on WLS. I listened to my coordinator and other people about UHC criteria. I was denied. All companies write their policies different. Had I known exactly what my criteria was, I would have been approved the first time around. I started trying to get approved about 1yr ago. I just found out what the criteria is for my coverage. Good luck everyone!!!

Don't give up yet!!  Sadly on many self funded plans the only way you find out is by submitting a preauth request.  These kinds of plans do not have to tell you ahead of time what the criteria is and can change it at any time without notice.  With that being said, the good news is that when they deny they have to tell you exactly what the criteria is and why they denied.  Our office has several huge books that we keep on each plan we work with.  We are continually updating the criteria information as we find out the changes.  Only one coordinator or nurse in a surgeons office can't possibly know the exact, current criteria on any one of hundreds of self funded plans they work with.  They can only share with you their most recent experience.  Sometimes insurance companies will tell you if you request that info but many do not. An almost standard requirement is a time period of MD supervised weight loss.  You can't go wrong doing that while you research and plan.  Make sure your MD writes detailed notes or sends you to a dietitian and exercise therapist etc....You will never hurt your case doing this and it always can help. Shake the dust off of your boots and dig in.....document their requirements and go get 'em!! Good Luck, Mary

This information isn't correct. Self funded (employer sponsored) plans *cannot* change at will, or any time without notice. They can change once a year, at open enrollment. If the plan is changing, they are required to let their subscribers know what is changing and when. And as a subscriber, when you call up, you are most certainly entitled to information that pertains to your plan. Any other information is pretty misleading.

I had a really easy time with UHC. I called before the process even started, found out their criteria and made sure I met those (and only those) criteria.

Don't give up.

You are describing fully insured plans.  Self funded plans can add or change criteria whenever they want .  I work with almost 200 seperate groups in our area.  They are governed under the Dept of Labor.  You cannot appeal to your state's Insurance Commissioners office as these plans are not under their control.  If they are part of a contract with a union your statement may apply depending on that union's contract with that particular  employer.  That would be very much a  case by case instance.   I urge you to look up the Erisa laws and regulations.    I am glad you had an easy time with UHC.  With many of the plans I preauthorize for our patients that is the case.   However there are a significant number of specific plans that you only access that criteria by sending in.  And all of those are also adminstrated by UHC.  The general criteria for fully insured plans is posted online.  Does not apply to self funded plans unless that particular group decides to use UHC's criteria.  Most of the time when you call in for the criteria you are getting the customer service rep's interpretation of the plan certificate they are trying to read.   Be thankful your case was "easy".  For many hundreds of others it is not so easy.    I do agree with you on the "Don't give up".  It is always worth the fight.