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UNITED HEALTHCARE INSURANCE

UNITED HEALTHCARE INSURANCE

Postby diegorgeous22 » Mon Jun 02, 2008 2:44 pm

Hey everyone,
I've been wanting a breast reduction for so long!..I just started my first job out of college and I have United Healthcare Insurance. I'm in Atlanta GA by the way.
For those of you that have United Healthcare Insurance I have a couple of questions:
1) Was the approval process easy?
2)What was the required grams/cc that had to be removed for coverage
3)Did you have to co-pay?
4)How did you go about getting Insurance to cover...did u complain to doctor/plastic surgeon or wot?

I am spilling out of a 38DD...so i'm sure i'm bigger than that. I definitely dont wanna be small just medium. I still wanna have cleavage..but i have dense boobs and i'm sure i can afford to lose about 1/3 of what I have and still be decent. Plus i really need the lift.

Thank you for responses!!
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Postby Keri58 » Mon Jun 02, 2008 2:49 pm

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I don't have United Healthcare but many here do so I'm sure you'll get lots of answers to your questions. Just wanted to say welcome and GOOD LUCK as you start your journey.
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Postby diegorgeous22 » Mon Jun 02, 2008 3:12 pm

Actually I found my answer as far as grams . It says 400grams on their website. I think that should be perfect for me! Dont wanna be too small. I'm gonna get this done for sure.
Did yall go directly to a PS or family doc or wot?
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Postby Keri58 » Mon Jun 02, 2008 3:24 pm

Did yall go directly to a PS or family doc or wot - after I decided on the PS I wanted to have a consult with, I called my PCP's office and got a referral. Check to see if you have to do the same thing.
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Postby YipeeDO » Mon Jun 02, 2008 3:33 pm

I have UHC, and they did approve my surgery and I did have the surgery done (425 taken off one, 460 taken off the other; I was a 38DD before, and am a beautiful 36C now. I'll also mention I'm 5'6, and was 135 when I had the surgery done.

So, do this: Google "UnitedHealthcare Breast Reduction Coverage." I think it was the third or fourth result down and you'll get into their internal system. You'll find loads of information here. I learned from this site that they generally require at least 400 grams on each side, and that your BSA be between the 5th and 22nd percentile. That webpage will also give you a link to determine your BSA, which they take into consideration when determining coverage. There's other gray areas I think when determining coverage that you'll see on this page.

My PCP did write a recommendation for the surgery, but I don't think it was submitted - it was a very casual prescription-type letter that was just given to me. My PS was the one to write the insurance company requesting coverage. Just to let you know, ALL insurance companies won't GUARANTEE coverage, but UHC did say I was covered for the surgery. Hope that helps! Let me know if you have anymore quesitons; I know what a nerve-wracking time this is for you! GOOD LUCK! :)
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Postby buckeyeinaz » Mon Jun 02, 2008 3:54 pm

Hi there! I moved to Phoenix 3 yrs ago after being in Atlanta for almost 15!! I love it there!! :-) Anyway, I have UHC insurance but here is the thing....each employer decides on the coverage that will be offered to the employees. So, coverages will vary even though we both have UHC. Mine was 80/20 coverage after a $ 350 deductible. I was also spilling out of a 38DD and was required to have a minimum of 500 taken from each side. When I first had my BR I thought my boobs seemed really small but now I guess they have dropped, fluffed, etc. because I am between a C and D cup depends on style and brand. I did go to my doc first who was willing to write a letter or do whatever she had to in order to help me get the surgery done. But, she never had to do anything. MY PS turned in all the necessary paperwork and it was approved very quickly. The best thing to do to find out your exact coverage is to call UHC. I never really could find anything on line that was as acurate as calling. Also, you'll want to ask your PS how much they charge or will be billing your insurance. I ran into problems because my PS charged the insurance company a fortune (of which I should have paid 20%) which was much more than I had assumed.

Good Luck to you!
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Postby TinaW » Mon Jun 02, 2008 3:55 pm

Hi! Welcome and good luck on this process. I have UH also, and my time was really easy.

1) Was the approval process easy? Yes, very, I just went to a consultation with a PS, he wrote a letter, and three weeks later I found out I was approved.
2)What was the required grams/cc that had to be removed for coverage Not sure, but he took off around 1lb on each breast.
3)Did you have to co-pay? Yes. Our total out of pocket for everything was around $1,000
4)How did you go about getting Insurance to cover...did u complain to doctor/plastic surgeon or wot? Alll I did was say I have pain and have to wear two sports bras when I went to my PS consultation.
BR/ May 19th, 08!
[2 week pictures added!]

ADVICE

1. Be patient.
2. Call your personal PS's office for instructions on the recovery process/procedures.
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Postby NJKerry » Mon Jun 02, 2008 9:14 pm

Hi Welcome!!

I too have UH. VERY QUICK approval - 12 days!!

I went straight to a PS as UH doesn't require referrals. I had a letter from my chiropractor submitted with the PS's letter.

The amount of grams needed is different for everybody - it goes by your height and weight. State your height on the shorter side - it works to your advantage.

MY PS also wrote in the letter that because of the size proper self breast exams are impossible as small tumors deep would go unnoticed. Good point, eh?!

The link for UH requierments is:
https://www.unitedhealthcareonline.com/ ... urgery.htm

Hope all goes well for you!!! Supposedly UH is one of the better in the approvals!
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Postby Ms.Em » Tue Jun 03, 2008 7:54 am

I have United Health Care and they denied me ALLLLL day long. It was a horrible 3 month fight only to get denied over and over again. I winded up paying out of pocket because I got tired of fighting a battle that I could not win.
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Postby car0linalove » Tue Jun 03, 2008 8:37 am

For those of you that have United Healthcare Insurance I have a couple of questions:
1) Was the approval process easy?
2)What was the required grams/cc that had to be removed for coverage
3)Did you have to co-pay?
4)How did you go about getting Insurance to cover...did u complain to doctor/plastic surgeon or wot?

1. Yes, it was approved about 3 weeks after my consultation
2. My plastic surgeon originally said about 500g but because of my height and small frame that requirement might be waved because he didnt think he could take that much out...
3. I have a plan with a Health Savings Account so I will have to pay the out of pocket max $1100 and then they pay the rest, good thing I have that saved up in the HSA!
4. First I called UHC and asked what I needed to do to get the process started, I was told to visit a plastic surgeon and have them submit the paperwork
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After pictures added


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Postby bellab5 » Tue Jun 03, 2008 9:57 am

Welcome! :lol: I have UHC and I live in Atl. I would first say check with UH it varies with ea. company. Check your EXCLUSION list :!: . I had UH w/ another company and it was excluded but not for my current plan. I'm not sure about the grams requirements, I went to 3 PS and was approved w/in a week for each. Its gonna cost alittle over 1000 for me out of pocket.
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Postby KSuzieW » Tue Jun 03, 2008 10:16 am

I don't know any info about insurance process, but wanted to say welcome diegorgeous (LOL like the name)......and good luck. Chuck any questions at us!!! :-)

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Postby YipeeDO » Tue Jun 03, 2008 12:58 pm

[quote="buckeyeinaz"]Hi there! I moved to Phoenix 3 yrs ago after being in Atlanta for almost 15!! I love it there!! :-)quote]

Buckeye: I'm currently in the Bay Area and am moving to AZ in a couple months - either Peoria or Surprise. Glad to hear you love it there - I've been getting a lot of mixed messages about AZ.
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Postby buckeyeinaz » Wed Jun 04, 2008 7:15 am

Hi YipeeDO - I'm sorry to say that it's Atlanta that I love, not Phoenix. Phoenix is just OK for me. I wish I loved it here and I'm trying to like it!! I'm hoping to get transferred back to Atlanta. Sorry!! :-(


Diegorgeous - Again, please be advised that all employers select differenct coverage/policies for thier employees. Just because we all have United Healthcare doesn't mean that our coverages will be the same or even similar. Give United a call and I'm sure they will give you all the info that you need. Best of Luck!
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Postby diegorgeous22 » Wed Jul 16, 2008 5:32 pm

Thx ladies for your replies!!

I have full coverage . My company has pretty good insurance.If i use a doctor in the network i dont think i will even have to pay anything at all.
I'm with UHC choice plus. And i dont need referals to plastic surgeons so i guess i will start going for consultations and have one of them write me a letter, since it seems like you all have letters written by PS not your doctors.
I hope to get approved! I'm sick of these big boobs. If i get approved, i hope to have SX done before it gets cold!

Does anyone have a PS they can recommend in ATL? Thx.
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