UHC won't give me my benefits and WLS requirements for 2012 - argh!
Has anyone who is trying to get WLS through UHC had this problem? They say 2013 plans are not loaded into the system. I mean, we can put a Man on the Moon, but we can't load this info 10 day before a New Year? Anyone else? Any advice? I have gone to HR and all they have is the Medical SPD. They've sent me back to UHC....
I had a similar problem with UHC when I looked into getting requirements from them back in July. No one could answer how many months of nutritional classes I needed, or any other requirements nor could they refer me to any approved providers and I called several times and each time with a different person. How is it that their representatives don't have the information you request? Their representatives should have a cheat sheet on this stuff by now. Any way, I went ahead with a program close to me because it seemed like most insurance companies require 6 months ($20/mo) plus copays for the specialist consults. I completed everything, including all the consults and got the call today from a nurse at Optum Health Care who said I completed everything they require except for going through an "Optum" Bariatric Center of Excellence so they would have to DENY my claim but I could appeal.
I knew the one in my local area said they were a Center of Excellence but I did not realize this is NOT a standard classification. Each insurance company has their own set of standards apparently. How was I to know that when UHC couldn't even tell me their requirements or even refer me to the 3rd party I was to apparently supposed to use? UHC's plan through my husband's employer uses a third party, "Optum Health Care Bariatric Resources to verify and approve all their bariatric surgeries. I was in shock for them to deny me only because I didn't select a center of Excellence approved by them nor could they tell me if I could just go to an approved one without going through the whole process again. They said that decision would be up to the surgeon. REALLY!!??!! Let me tell you, I cried and cried, screamed, cussed and screamed some more!!! I have to fight my tears typing this now. I have spent a lot of time, money, and effort to lose weight to only be told I didn't follow the proper steps but how can I prove that I was not given the proper information from UHC? I only hope someone has the common sense to allow me to go through their Center of Excellence program without starting over the whole program and consults. I can't wait until Monday morning. You know I will be on the phone on Monday morning with all involved.
I will post what I find out for any of those who might be in the same position. Please keep your fingers crossed. I basically had to go through trial and error but I guess they want us to not be successful so they incur more costs! That's all for now. Sorry to vent so much.
I hope you finally received the information you were looking for and are on the right path.