question about requirments - ThinnerTimes

mommyto-3 · 05-13-2008, 07:01 PM

i have a question....i have called my health insurance company(united healthcare) and was told i have to be covered by them for 12 consequtive months before i can even be consider for weight loss surgery. my question is...i would like to try and get everything done before hand that i can, so when november rolls around (my 12 month date) i can turn in all my papers for the surgery and get things going. Well, i don't know for sure what is required. no one will tell me for sure. I know i have heard alot about 6 month supervised diets and such, but nothing from my insurance compnay. i was hoping maybe someone had some insight into this. i would hate to have to wait til november to even get this started and have to wait another 6 months on a diet that i could be doing now. Any thoughts or ideas about what i should be doing now would be very, very helpful!

MiladyB · 05-13-2008, 08:38 PM

Quote:

Originally Posted by mommyto-3

i have a question....i have called my health insurance company(united healthcare) and was told i have to be covered by them for 12 consequtive months before i can even be consider for weight loss surgery. my question is...i would like to try and get everything done before hand that i can, so when november rolls around (my 12 month date) i can turn in all my papers for the surgery and get things going. Well, i don't know for sure what is required. no one will tell me for sure. I know i have heard alot about 6 month supervised diets and such, but nothing from my insurance compnay. i was hoping maybe someone had some insight into this. i would hate to have to wait til november to even get this started and have to wait another 6 months on a diet that i could be doing now. Any thoughts or ideas about what i should be doing now would be very, very helpful!

The 6 month supervised diet is pretty standard but different insurance companies accept different things. With mine they required using a specific medical weight loss program, with others they just had to be followed monthly by their pcp. Is there any way you can hunt down their criteria? I know my insurance company has a website and I was able to find the criteria on there.

You will also want documentation of any co-morbidities. Most doctors also require an ECG, Sleep Study, possible EGD and other lab tests. Only problem is that there may be a certain time frame on the tests so I wouldn't jump into getting those done too quickly.

What you may want to do now though is start searching out possible bariatric surgeons so that you know who you would want to do your surgery.

Godsblessedme · 05-13-2008, 09:01 PM

pretty much exactly what Beth said

i would call and talk to the review department or whatever its called and dont settle for "i dont know" they know

mommyto-3 · 05-14-2008, 01:11 AM

I did call a week or two ago, and one person told me they flat out will not cover it. I thought that was wrong so i called back and this person told me they will after the 12 months, but until i had reached the 12 months she really couldn't tell me what the requirments would be. She also told me there would be a nurse calling me within the next few day, well that never happened so i called them back and the person i wtalked to that time told me they had no idea why someone would tell me a nurse was going to be calling me. So i am lost...lol. I have already went to a seminar and know what surgeon i want to do this, the big question is....what first??? I will try calling them agian tomorrow and just demand i talk to someone who knows what they are talking about,but thats the hard thing, you never know who knows, and who is just saying whatever to make you happy and get you off the phone.

Thanks for the advice ladies!!

mommyto-3 · 05-14-2008, 01:14 AM

fogot to say, i went to their website and i cannot find a thing about weight loss of any kind...surgery, diets, prescriptions, nothing!

Debz · 05-14-2008, 07:26 AM

Find a surgeon in your area and go to one of their weight loss seminars. The insurance person for that office will typically be there and really be able to help with many of your questions. They are the ones that know what each insurance company needs in order for your paperwork to be submitted, as they do it every day.

Kimberly76 · 05-14-2008, 09:00 AM

If you are getting more than one answer out of your insurance company for the same question or a "I don't know." I would be assertive and say, "Thank you for your time, may I please speak to a manager." Having it directly from the "horses mouth" is so much better then someone that really isn't sure and trying to give you an answer. And then ask the manager to email you something being polite and assertive normally gets me results.

Good luck,

Kimberly~

mommyto-3 · 05-14-2008, 04:20 PM

I think i may be getting somewhere..lol. I talked to the insurance company today and was informed that the surgery is covered if I have a diagnosis of "morbidly obese" well, that shouldn't be a problem, i have a BMI of 60! Anyways, the lady i talked to this time seemed very knowledgable, thank goodness. She took my number and is going to be giving me a clall back on monday(at the lateset) with all the requirments. Turns out I may not have to be on the insurance plan for a full 12 months like was thought earlier, so hopefully when she calls back she will have some good news for me!

Godsblessedme · 05-14-2008, 04:26 PM

that is terrific news! i hope the woman calls you back be sure and update us

mommyto-3 · 05-14-2008, 04:42 PM

I just wanted to say that I have been on other health boards and forums like this and never have gotten half of the response that I have already gotten from you guys! You truly are awesome!! I'm gonna love it here.