United Healthcare... conflicting info on requirements

Hi, I also have UHC ChoicePlus. Congrats on your approval and pending surgery date. I hope I'll get mine soon too. I'm slowly getting there, my psych eval is next week.  I've been unable to find any information on the UHC  website regarding WLS. But, when I called and spoke to at least 3 different reps, the care coordinator told me that a 6 month diet was not required for my particular plan either.  When I asked where I could find any information on their website, I was told it wasn't viewable and that the reps would need to provide the information over the phone. Can you tell me specifically where you found the information?   Thanks

Its definately plan specific, we had United Healthcare with my Husband's employer and WLS was excluded. My employer's did not so when he was laid off we switched insurances and I was approved for a revision within 3 weeks

I thought I'd chime in here as I just got off the phone with my Nurse/Case Worker at UHC

I have UHC Options PPO and she said all that is required is that the surgeon schedule surgery and request approval from UHC.  I specifically asked if there were any pre-op requirements from UHC and she said no, it's up to the surgeon.

When my surgeon first contacted UHC, they said the same thing (schedule the surgery and request approval) but after we scheduled the surgery, they said I needed to do the 6-month medically supervised diet.  What has happened with you in the last month?

Thought I'd answer this (really late)

I went to a seminar with one group in my area and wasn't sure I wanted to go with them, and then found another group in my area and missed their seminar last month, so I am going to their seminar this month.  (I am leaning towards VSG and the first surgery group didn't do it -- the 2nd one does -- which will be denied then appealed, etc thru UHC)

I had MDIPA and July 1st was switched to United Health Care with the State Insurance.  When I called they said that it had to be 6 months of supervised weight loss, or 2 three month cycles.  This has to be within the last 2 years I believe.  They will not give me a definate answer regarding the Vertical Sleeve procedure.  They say that they will cover the band and gastric bypass, but for other people it will depend on the state that they live in.

When I called UHC Optimum Choice last week, they told me it's my COMPANY who chooses the six month requirement - that they present all the possible options, and the company decides what they want to write in to their policy.  This made sense to me - especially in view of the many different versions we've heard here.

In my case, my company chose to exclude ALL WLS procedures.

Argh!

Sheri

I'm soo nervous about this. I have UHC ChoicePlus and I haven't been able to get a straight answer out of them as to whether or not I need a 6 month supervised diet. Alot of pple with this plan don't seem to need one, so that's promising but I'm nervous that something will go wrong last minute.

I've also heard this thing about your BMI being higher than 40 for 5 years. I haven't heard it from my insurance company but I have from other people. My BMI has been above 35 for over 5 years but only over 40 for 1.

I'm nervous about this whole process. I have all of my appointments scheduled, I just don't want anything to go wrong.

Im going through the same thing right now.. I have UHC and im currently trying to get the sleeve done and for the past 5 years my BMI has averaged about 36 to 39 and im nervous they are going to deny me, idk if they are really strict or if they go case by case but im talking to a case manager Sep 12th so i'll see,, Good luck i hope you get it!