Well no surgery for me

If no one can find the actual requirement, demand that the insurance company and/or the clinic PROVIDE it.  They cannot just say "wer're sorry, there is a 6 month requirement" and not provide documentation of it!  You are surrendering way too easily on this, IMO.  If you want this, fight for it, dammit, instead of just whining about it!

Lora

When I first went to my surgeon I discovered I had to have a 12month supervised diet. To do it at the Bariatric office would cost over $300 a visit because my insurance did not cover it. I did my 12 months with my PCP and only paid my co-pay each month. I made it the 12months and lost the required 10% of my body weight. My surgery is on June 24th. Don't give up in 6 months you will wish you have started now. That is how I looked at it when I thought I would never make it a year. Now here I am with a month left until surgery and I am so glad I went through all of it to get to this point.  

I am sorry you are going through this - you must be disappointed.  However, it took me only about 30 seconds (if that) to find on the internet what United Health Care's bariatric surgery approval procedure required.  The policy was updated on April 1, 2013, and clearly states:

Bariatric surgery is medically necessary when ALL of the following criteria have been met:
*  Body mass index (BMI) = or > 40 kg/m2 or BMI 35.0-39.9 kg/m2 with one or more of the
medical comorbidities described above.
* Documentation of a motivated attempt of weight loss through a structured diet program,
prior to bariatric surgery, 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. (NHLBI, 1998)
*  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. (NHLBI, 1998)

 

People really need to be an advocate for themselves so as not to be caught by these types of surprises.  This information was clearly available and was "made know[n] ahead of time so people can plan financially for it!" 

I do hear your disappointment though.

I had found this too during my fight. I was encouraged, but if you keep reading in that document you will see the "fine print" that says that individual plan requirements supersede that general policy document.

So, despite it being made publicly available, it was completely irrelevant in my case.

I am with you, though, on the need for people to self-advocate and fight.

Don't give up, if you are going to try and diet, why not go visit your pcp once a month thoughout it for 6 months. Worth a try. I had to do the 6 month diet...TWICE!

 

As for the money, there are so many ways to scimp and save. Once less coffee here, no eating out, no movies, no sweets. Coupon coupon coupon. I think if youre really able to hold on to a good healthy diet you will save money in the long run.

 

Good luck, I know its frustrating.

Have you been seeing your PCP every month for the last 6 months? If so you might be able to have them fill out the papers you need. I am sure that your weight was mentioned at least once a visit, mine always was. If they are willing then you can resubmit your paperwork and see if they approve.

If they changed the policy in April, can you ask to be grandfathered since you had already started the process when the requirement changed?

And I second what another poster said: If you have 3 months from what you've been doing, plus 3 months of something else (Weigh****chers? Your PCP?) maybe they can add it up. Mine was part WW/part the surgeon's plan.

I think you are seriously misunderstanding something.

If you did not get a flat out denial that they don't do WLS coverage, you ARE eligible. But you have to meet their parameters. For me, it was either 6 months of consistent, demonstrated loss with visits no more than 28 days apart with both the doctor and nutritionist OR lose 10% of my body weight. I lost more than 10% and was approved in just over 4 months. But two months later I would have been approved if I had not hit that 10% mark.

MANY companies require some work ahead of time...and it makes sense. If people are not willing to work for it, they they are less likely to be successful because WLS is not a magic trick, it is a tool THAT TAKES WORK.

I think you need to calm down, get yourself together and clearly understand the requirement from UHC. And what have you spent beyond co-pays? I am not sure about the 'wasted a lot of money' comment. My co-pay to the specialist was 40$ each visit and I was darn happy to pay it as part of the process!

 

You're accepting NO for an answer and that's exactly what the insurance company wants. 

I just won my battle with my insurance through external review with Lindstrom Obesity Advocacy.  I refused to accept NO as an answer.  I started this journey last year at this time and just FINALLY got approved.  I'm now just waiting to receive the hard copy of the approval so the surgeon's office can schedule me!  You can always contact them and explain everything to them and they'll help you.  If you have any questions you can also message me. 

 

Good Luck and don't give up. 

I guess what I am saying here is that Insurance companies make it so hard to get information and  give wrong information.  I am just so frustrated with this all.  I just feel that I was given wrong information and did not go about this in a wise format based on that info.    I had no problem waiting the 6 months.  I would have then spaced out my pre surgery appointments that would have not caused me to spend the huge amount of money I have already spent.  I would have had the expensive test done at a different time instead of rushing it in 3 months.  I found the generic United Healthcare plan but it states  "Additional information for medical necessity review, where applicable: this means it is up to you specific plan.  I was told my plan did not require a waiting period much less 6 months.  I still can not find requirements specific to my company plan anywhere.  Waiting on the clinic to review and my company benefits coordinator to call me back.  I am working paycheck to paycheck and this has really set me back financially.  I just do not have the money to start over. I might reconsider but I doubt it.  I want to thank you all for your encouragement.  I have learned so much form this Forum and I will continue to read and post.  Everything happens for a reason so maybe my Lord and Savior has stopped this for a reason.