United Healthcare PPO - What the Heck!?!?
Goldie, I've pasted UHC's new revision language below. My interpretation is in red, but I'm still going to call and get confirmation tomorrow. Hope this helps!
"Surgical revision or a second bariatric surgery is proven for inadequate weight loss if the original criteria for bariatric surgery (BMI, co-morbidities and patient selection criteria) continue to be met. (So with inadequate weight loss, it's looks like you'll have to meet the original patient selection criteria, whi*****ludes the dreaded 6-month diet! )
Surgical revision of bariatric surgery is proven for complications of the original surgery, such as stricture, obstruction, pouch dilatation, erosion, or band slippage when the complication causes abdominal pain, inability to eat or drink or causes vomiting of prescribed meals. (In this paragrah, there's no language about meeting the original criteria.)
Patient selection criteria for bariatric surgery includes:
"Surgical revision or a second bariatric surgery is proven for inadequate weight loss if the original criteria for bariatric surgery (BMI, co-morbidities and patient selection criteria) continue to be met. (So with inadequate weight loss, it's looks like you'll have to meet the original patient selection criteria, whi*****ludes the dreaded 6-month diet! )
Surgical revision of bariatric surgery is proven for complications of the original surgery, such as stricture, obstruction, pouch dilatation, erosion, or band slippage when the complication causes abdominal pain, inability to eat or drink or causes vomiting of prescribed meals. (In this paragrah, there's no language about meeting the original criteria.)
Patient selection criteria for bariatric surgery includes:
- Documentation of a structured diet program whi*****ludes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program for a minimum of 6 months.
- Active participation in an integrated clinical program that involves guidance on diet, physical activity and behavioral and social support prior to and after the surgery.
- Psychological evaluation to rule out major mental health disorders which would contraindicate surgery and determine patient compliance with post-operative follow-up care and dietary guidelines."
Hi, I called UHC and they confirmed that my interpretation is correct. Unless you've experienced mechanical failure of the first surgery, you'll have to meet the original criteria.
ETA: Oh, here's UHC's online policy (it was revised on 9/17/09).
https://www.unitedhealthcareonline.com/b2c/cmaIndexResult.do ?channelId=016228193392b010VgnVCM100000c520720a____&htmlFile Path=/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticF iles/ProviderStaticFilesHtml/MedicalPolicies/Bariatric_Surge ry.htm
ETA: Oh, here's UHC's online policy (it was revised on 9/17/09).
https://www.unitedhealthcareonline.com/b2c/cmaIndexResult.do ?channelId=016228193392b010VgnVCM100000c520720a____&htmlFile Path=/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticF iles/ProviderStaticFilesHtml/MedicalPolicies/Bariatric_Surge ry.htm
Most Active
Recent Topics
