United Healthcare

I'm just starting out my journey with United Healthcare. Just wondering what people's experiences are?? Their requirements include 5 years dr documented BMI over 40 (which I have). I'm just wondering if its really that simple (I don't think it is). My primary dr has given me the last 5 years which show at least 40 the entire time). But I suspect it won't really be that easy. Thanks guys!!

If you meet requirements, you will sail through. Do you mind if I ask who your employer is? Just make sure that your submitted BMI is clearly documented as 40 and you have plain documentation to show the other dates, and you are good to go!

I have United with the same requirements and didn't quite meet requirements (BMI of 38.3 + comorbids on first submission); they didn't care that I had worked with my doc on physician supervised weight loss on and off since 2008. They didn't care that I could show BMI of 40 when I wasn't working with my doc. I fought thru two denials, and hired Walter Lindstrom's office. They handled the final appeal, which went to hubby's employer (ING). It was a one shot deal- if I won, I won, and if I didn't, I was done. Well, I won the appeal. The bigger news is that ING's medical director decided on the basis of Lindstrom's arguments that their policy was outdated and ordered United to change it to reflect prevailing medical thought.

I tell you this because if you are through ING, you should have looser restrictions and I would be curious to know if that is not the case. If not through ING, know that if something goes wrong, you do have another case that has been successfully argued and overturned against those requirements.

From what you say, you should be fine, but I wanted to give you some additional details should you need them good luck!

I am just starting out too and I have UHC. I have to go thru 12 months in a weightloss and exercise program before they will approve the surgery. I have a BMI of 46. You don't have to do the weightloss program for a year?

See...they havent mentioned that in my process yet.  When i called and when my drs office called they indicated that i needed 1.  a current bmi of over 40.....2. a 5 year history of a bmi over 40....3.  the dr needs to be in the network (so does the hospital)  4.  have to be over 21 i think....

 

do you work with ING also??  requirements are different b/w companies but i'd think some of the processes would also be the smae.....i dunno.  do you have the other requirements (5 year bmi history etc??)  I can't find the actual information on uhc's website...i would have thought it would be available that way.  I'm really just at the point that I'm going through all my drs requirements so they can actually submit for approval and then we'll see what they say.....

 

have you actually submitted your insurance request yet?? 

i called UHC a couple of times and spoke to them and yes, i need a 5 year history of high BMI,  in network doctor, etc. but they said they don't require the documentation of a 12 month diet and exercise plan. i asked that they send me a list of the requirements since it's not on their website and they said i have to acquire that thru my HR department which sounds odd to me.

thanks for your response.

oops, forgot to answer your last question - no i haven't started to submit for insurance approval yet because the surgeons office is expecting me to attend 12 months of weight loss and exercise programs. once i've completed that then they will submit all necessary documentation to the insurance company for approval.

I'll definitely keep you updated.  I've got my last psych evaluation on Aug. 6th and am hoping to have my request to submitted and responded to by the end of August....I'm trying to get my hands on my document now too.  I'm hoping its as straight forward as what they've told me...fingers crossed.  If not, I'll just buckle down and start doing the other stuff too....but at least i'll have all this other stuff out of the way too :)  I wish i could find someone that had a similar situation as I do....same BMI, similar background....there's a woman on the boards that's been successful fighting UHC....dont know if she had a dr supervised diet or not in the end but she won appeals etc.....not sure I've got that much energy.....

I'll let you know what I find out :)