Centennial and United healthcare

I have someone close to me that is hoping to have gastric bypass with Dr. Houston at Centinnial.  Does anyone know the answer to the following questions? 

1. Does he take United healthcare
2. What are his requirements
3. What is the paying options with insurance. Are you out of pocket a large amount? 
4. If he doesn't take United healthcare is anyone in his office taking it??

Please if any of you are on that have United healthcare and this special friends insurance is United healthcare Choice plus plan, and you know about any of this... please contact me a.s.a.p. I would LOVE to talk to you!!!!

please mail me at [email protected] for a faster response.
God bless you all,
Tina

Hi,

Yes Dr. Houston takes UHC.
Here are the standard UHC requirements although after he goes to the seminar they call and get his specific plans requirements along with what his out of pocket will be as it can very depending on his plan.

 Insurance Requirements:

United Healthcare (12/20/07) (reviewed 4/08)

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=cdc94e74bc62c010VgnVCM100000c520720a____

·         BMI 40 or greater OR BMI 35-39.9 with at least one of the following comorbidities such as cardiovascular disease including stroke, myocardial infarction, stable or unstable angina pectoris, coronary artery bypass or other procedures, hyperlipidemia uncontrolled by pharmacotherapy, type 2 diabetes uncontrolled by pharmacotherapy, hypertension uncontrolled by pharmacotherapy, or moderate to severe sleep apnea with a respiratory disturbance index (RDI) of 16 to 30 or apnea-hypopnea index (AHI) >30 as documented through the completion of a laboratory based polysomnography

·         Previous failed attempts at losing weight using more conservative therapies

·         PCP Letter

·         Diagnosed as Morbidly Obese for the past 5 years (documented in Medical Records)

·         18 years of age

·         Psychological evaluation

·         Gastric bypass, BPD/DS and Lap-band procedures are covered

Hope this helps..

T

I guess one of my biggest conerns is the 5 year documentation.  She hasn't had a recorded weight in office for many years because the scales wouldn't weigth her.  She did have plenty of documentation when she was pregnant but that was over 15 years ago. her recent medial history has no recorded weights either.. so what do you do? wait another five years??? That is my question...

Thanks
Tina

Has she gone to any doctor, for any reason within the past 5 years?  I had an ER record where the doc stated that I was morbidly obese.  That may help her if she can find any and all doctors, surgeons, and weight programs (weigh****chers, fitness centers, etc) that documented her weight in their records.    for instance, a person went to get a flu shot from a doctor, or even a person went to their employer fair where it was stated, "March 15, 2004 - patient came for flu shot; height 5'4, weight 278" etc

that is just it... she has not got any recorded weights for several years because scales wouldn't weight her. I just wondered what they did in that instance?
If she could appeal on medical necessity?? she has her pregnancy records from 15 years ago when she had a BMI over 40 I just wonder if that would work along with maybe records stating she was morbidly obese?? 
Thank you all so much for your help... we are calling centennial tomorrow to get the info... I just wondered if I could gather any info before then.

God bless you all
Tina

Tina, I don't know what the solution would be...  hmmmm, but I would just say talk to the doctor's office.  I know they have to see this kind of stuff all the time...  and maybe they have some suggestions.  I wonder if her doctor, if he has known her for 5 years, could write  a letter and say he has seen her for so many years, and that he has not been able to weigh her as the scale would not go that high?  I don't know.  But hopefully the surgeon's office will have some solutions..

If you read the requirement it says " Diagnosed as Morbidly Obese for the past 5 years (documented in Medical Records)" It does not say weight noted in file the last 5 years. So if  her Dr were to write something saying Diagnosed as Morbidly Obese I dont see why they wouldn't take that. It would meet the requirement at that point as his diagnosis was morbidly obese.

I was scared of this requirement too but only because for 3 of my 5 years my BMI was either almost 35 or 35 and I had no comorbids at that time. The Dr's office even said they thought I would get denied. But I was approved on the first try. So I really think the requirement can be interpreted differently.

Hope that brings some hope to you and your friend.

That's a very good point Telisha...  Tina has your friend gone to a doctor at all in the past 5 yrs?  Usually, upon exam for anything, they will write out a long list of diagnosis codes as long as your arm it seems...  and they indicate anything and everything including whether a patient smokes, has high blood pressure, a history of ???, etc etc.  Has she seen a gynecologist?  They too use these codes.  Heck I would grasp for anything & everything if I were her!  I hope she is able to find some sort of loophole, record, document, or a doctor who will write a letter for her!!

Hello, my name is Sherrie and Tina is my sister.  She was asking questions for me but then suggested I join the site.  I appreciate all responses to her questions.  I actually have been to the doctor at least once in the last 5 years and some of those I might have been weighed...I am just not sure yet.  I am going to find  out some more information today and will go from there.  I am still in the beginning stages of everything and have no idea what I am doing.  Thanks for everything and have a wonderful day!