United Health Care - Choice Plus - Page 2 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

poet_kelly · 09-13-2009, 07:27 AM

Most, if not all, doctors keep records for at LEAST ten years. Some keep them practically forever. I don't know about dentists, but I would guess it would be similar. And yes, though records should work as well. Now, weight loss clinics I don't know about, but you can certainly check.

Kelly

Vikkator · 09-13-2009, 08:51 AM

I worked with my PCP to gather dates. I was in various programs (Weight Watchers, a couple of gym memberships, LA Weight Loss, Atkins (on my own), etc. I had a 25+ year history of weight loss attempts, but I wasn't morbidly obese until I decided to have the surgery. I filled out a form with the dates and my PCP signed it. I had discussed the various programs with him from time to time, but he didn't oversee everything I did. It was acceptable enough to UHC and I was approved. My BMI was 39.5 and I had no co-morbids other than bp a little high but not dangerously so. I think it was the history that was the kicker for me.

If you can at least document your attempts at weight loss, and get your doc to ok it, you should be set.

psjim2007 · 09-13-2009, 09:12 AM

Quote:

Originally Posted by Vikkator

I worked with my PCP to gather dates. I was in various programs (Weight Watchers, a couple of gym memberships, LA Weight Loss, Atkins (on my own), etc. I had a 25+ year history of weight loss attempts, but I wasn't morbidly obese until I decided to have the surgery. I filled out a form with the dates and my PCP signed it. I had discussed the various programs with him from time to time, but he didn't oversee everything I did. It was acceptable enough to UHC and I was approved. My BMI was 39.5 and I had no co-morbids other than bp a little high but not dangerously so. I think it was the history that was the kicker for me.

If you can at least document your attempts at weight loss, and get your doc to ok it, you should be set.

I have myself 15 years of weightloss attemps. I have gone through Weight Watchers, Crazy diets that I have crossed the border into Tijuana medically supervised, Hollywood, Atkins, etc., etc., I am barley in the process of seing the surgeon in October. I am hoping that I am approved, I just can't handle this weight any longer.

blevy · 09-14-2009, 07:50 AM

Matt, I used my weightloss clinic info and it made up for the 2yrs history and 3mthns supervised diet, I have Aetna, but I don't see why going to a weightloss clinic wouldn't work with any other ins. co.!!!! Good luck and keep us posted!!!

deeteeceecee · 09-14-2009, 06:16 PM

Hey, Matt

I met with the surgeon and he told me that they will submit my info. to UHC by wed. morning and it will take 7-10 days at the most before we here anything..(we have the same requirments) so as soon as i hear something i will update you.

MattR · 09-16-2009, 10:47 AM

Thanks everyone for the info!

I also wanted to ask did some of you go to a primary doctor first to be referred to a WLS doctor? Or did you go directly to a WLS doctor?

Vikkator · 09-16-2009, 02:07 PM

I started thinking about having the surgery and signed up for a seminar through the bariatric surgeon's office. That was the first step. I didn't go through my PCP until after my seminar, because it was then that I discussed my past attempts with my PCP. When I met with him, I had put together a timeline of my various weight loss attempts. The bariatric surgeon had given me paperwork to fill out and have my PCP sign. The paperwork included an area where we filled in the weight loss attempts. I didn't have to show any 'proof' other than getting my PCP to sign the form. My PCP also told me that I had made a good choice of a surgeon and that his group was highly recommended, plus he knew him.

I don't really think it matters who you go to first unless you need a referral. My plan dictates that I do not need a referral. I just found my doc through researching bariatric doctors in my city.

deeteeceecee · 09-16-2009, 10:25 PM

Matt

I went to a seminar to get info. about WLS. Then i talk to my PCP about it because i needed a referral.

lvl0rg4n · 09-17-2009, 08:45 AM

I'm pretty much seeing my PCP as the last thing to do. I even have my pre op consult before going to my PCP. My, my - won't he be surprised! Though I did tell him a while ago I was thinking about it.

Randi · 09-17-2009, 10:45 AM

Quote:

Originally Posted by MattR

Well I finally called the insurance company and they told me it is covered under my plan with some requirements.

Minimum BMI of 40

Over 21 years of age

Minimum 5 years of documentation that prove weight issue - I haven't gone to a family doctor every year consistently. Where could I get this documentation? I've only been to a dentist office and a weight loss clinic where I remember being weighed.

Require Pre-Certification - I have no idea what this is. I'm sure this is something the doctor has to do or I could be wrong.

I haven't read all of the other responses yet, but wanted to reply to this post...

I also have Choice Plus and when my surgeon's office initially requested a prior auth from the insurance, I was denied stating I did not meet all of the requirements. I also had not been to a doctor EVERY year for 5 years. I did go to Weight Watchers though and had my weight records to prove it. I contacted WW and they wrote a letter on my behalf confirming ONLY the dates I had paid and participated and I sent that in along with the copies of my weight records. I also went to my former doctor and she wrote a letter on my behalf listing the weights she did have on record for me along with medical conditions I have that are/were impacted by my weight and her recommendation for surgery. I filled out an appeal form provided by the insurance company and a letter requesting an appeal of their decision to deny coverage and sent all of my letters from WW and doctors and medical and weight records and within a month they reversed their decision and notified me that they WOULD cover the surgery.

It took an extra month, but if they had stuck to their denial, I'd have had to wait another 2 years...so it was worth it! Just gather as much documentation as possible and try to get letters from doctors or anyone else you can incase you need to appeal a denial of coverage.

Good Luck!