Question:
Can someone give me advice on qualifying with UHC EPO?

I am wokring for AOL and they have UHC EPO, I want to do this right the first time, can I get some advice??    — denisemichelle78 (posted on September 25, 2004)

September 25, 2004
Go see a surgeon, he will submit approval for you. UHC does not determine medical necessity, so if your plan covers it, and your surgeon says you need it...you're approved.
   — RebeccaP

September 26, 2004
Read this site about surgery approvals. A lot of insurance companies require a letter. I would document all of the diets you have been on (how long and results). Why you want this surgery. Your doctor should include any history (visits that you may have had with the doctor) of weight loss trys and medical history for having this surgery (illness due to weight). These steps are important because more and more insurance company are rejecting requests because they think this is a quick fix and not long term. It is also a very expensive surgery. Good Luck!
   — Linda R.

September 26, 2004
Most insurances these days are requiring a diet history and a psych evaluation at minimum. Other insurance want to see proof of a doctor's supervised diet. I think insurances want to make sure you've exhausted all avenues to try and lose the weight and want to see a proven history of that. I also have UHC but mine is the POS. My particular UHC policy requires 6 months of a doctor's supervised diet w/monthly weigh-ins, a psych eval and a 5-year documented history of obesity. A BMI over 40 or a BMI under 40 with two co-morbids. Your best bet would be to talk to other people at your company that have had surgery and ask them how to qualify.
   — Shayna T.

September 26, 2004
Hi...I do all of the approvals for my surgeon...I just did one with UHC for an AOL employee...They just required a letter...Ht, WT, BMI...plus your psych eval...no documented diet history or anything. Just do your psych eval and you wont have any problems...good luck! Mandy
   — Mandybub

September 26, 2004
I work for UHC, and they do determine medical ness. But as long as there is no exclusions in your policy, then you should not have much of a problem. Like the previous posts said, A letter needs to be sent in with history and weight and any medical problems. one thing I can let you know from an inside veiw is make sure your doctor gets a fax number to fax the info into UHC, if it is mailed it will hold up the process by at least 2-3 months if not longer, once UHC gets the request in the corrected department, approval usually takes less then 2 weeks, mine actually only took two hours from the time of them recieving all info they needed......Good luck
   — JANEL C.

September 27, 2004
I worked for UHC for five years...when did they change thier policy?
   — RebeccaP