United Healthcare? - Page 2 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Vikkator · 06-04-2008, 03:27 PM

Well, congrats on your weight loss Traci. I'm thinking I might look a bit hollow at 120 pounds too. My daughter (age 19) weighs more than that and she looks skinny. 140 would be perfect, I wouldn't even mind 150. I'm hoping a year from now that I'll look and feel a whole lot better.

Sue0609 · 06-14-2008, 09:38 PM

I thought I'd chime in since I have UHC. I had my surgery at Tufts in Boston and the person there who handles the insurance said UHC is one of the more difficult and BC/BS is one of the best. I don't think she is aware that UHC often is just the administrator and they only administer what the employer wants. My summary description said "weight loss surgery is not covered unless there is a diagnosis of morbid obesity". I called UHC and they insisted that all that was required was a letter from the doctor listing my height, weight, BMI and that they believed RNY (of lap-band) would be good for me. Tufts didn't believe me. I hadn't made a decision on what surgery to get so Tufts submitted it as lap-band. It was approved almost instantly. I decided to do RNY and they send in a new letter and when I hadn't heard after a week I called and it was approved within 3 days. With UHC it's all about the plan. I am under COBRA now, but I worked for years for a large company that is a total grind to work for (I gained ALL my excess weight while there) so they provide great benefits.

The administrator must have had experience with other UHC plans in Boston that are not as generous. Tufts was pretty sure I would need 6 months of supervised diet and maybe even 5 years of weight to prove it was an ongoing issue. NOTHING was needed but what I listed above. UHC couldn't care less if I gained or lost weight before the surgery.

frances · 06-15-2008, 09:00 AM

Quote:

Originally Posted by Vikkator

I did the psych eval. it took the guy 10 minutes. He looked over my questionnaire and said 'it looks like you wouldn't have any problems with this surgery'. (no sh$$!) It cost me $185 to find that out! What a racket. No wonder health care costs are so high. This guy makes $185 for 10 minutes of work! Sheesh! And, don't get me started on the costs of drugs! I just wonder how much a shrink makes in a year. What a sweet job that's got to be.

Anyway, I had my nut seminar on Thursday and started my pre-diet yesterday. I'm on my way and can't wait to get this done.

I would say that the evaluation you got would be tentative at best. How on earth could he make a determination like that in ten minutes - unless you had a relationship already established with him.

That is actually kind of scary.

Vikkator · 06-16-2008, 06:54 AM

There was no prior relationship. They gave me a questionnaire to fill out before I came in, which I brought with me. It contained yes and no questions. I could have bullshitted on the whole thing. I frankly was flabbergasted about this. He had some kind of computerized notebook and entered my answers into it.

Either way, I got what I wanted, but I agree, it's scary.

tx mom · 06-16-2008, 07:48 AM

i have uhc and on my policy you have to prove that you have been morbidly obese for at least five years. and from what i have heard that is pretty standard.

Vikkator · 06-16-2008, 11:14 AM

I talked to the surgeon's office about this, and they said it all depends on the employer and the type of surgery. I haven't been morbidly obese for the past 5 years, but have been off and on for the past 20 years. I had lost almost 50 pounds in 2006 and gained it all back (and a few extra pounds) in '07. I've decided that if they turn me down, I'll do what I can to lose as much as I can (and get breast reduction surgery). I am doing Curves now and started the pre-op diet a couple of weeks ago. I've lost about 6 pounds, but need to lose at least 100 more. I'll just have to wait to see how things go. I probably won't meet the surgeon until August and won't probably have surgery until September or October.

determined55 · 07-30-2008, 04:40 PM

I have uhc - learned that they would cover 90% - yay!!

not so fast - i later learned that they require that i have 5 consecutive years of weight monitoring - no skips - if you are late for your dr visit - then the count starts over.

I felt absolutely destroyed after hearing this. I'm a fat person with a fear of scales - even when i went to the dr. often times i wouldn't let them weigh me. i have all of the health issues that makes me a perfect candidate - but i don't have 5 consecutive years of weight monitoring by a physician.

i'm just saying this to make sure that you check everything before you get your hopes up too high.

if anyone have any idea on how i may deal with this situation please let me know.

mochababy · 07-30-2008, 05:27 PM

I have UHC and I too gained 19 lbs in 3 months before my surgery and I was still approved. I was asked about different weight loss attempts but nothing that was monitored or documented. I truely believe that the way that my surgeon worded the request and his recomendations have a lot to do with it.

Good Luck!

mochababy · 07-30-2008, 05:38 PM

I had my surgery at Mariam Hospital, RI, my surgeon was Dr. Viviathanan. I received wonderful care at the hospital. I had no complications, went home on the 3rd day. I had some discomfort the first week but that was about it. Last week I started at the gym, walk/jog 2 miles on tread mill. So far I have lost 32 lbs. Dr. Viciathanan is my hero!
I received a bill for $672 which is the portion that UNC did not cover. Considering my bill was over $31,000 I do not htink that is much to pay, and well worth it!

Vikkator · 08-06-2008, 08:43 AM

Wow. I wish I had that kind of co-pay. I know that with our plan, we pay 10%, although it's confusing because I have a $2,000 deductible limit. I've had some other health issues earlier this year and have already used up some of that. I guess the Ins co will kick in after I've spent the $2,000, but I'm still confused because of the 10%. Does anyone know how this works? If I go over the $2,000 deductible, does that mean that they will pick up the tab in full for anything over that? If that's the case then I will be extremely happy. I've been thinking about getting a loan, but may not need to if the ins covers it.