**LaP HaPPy**

Rene, I talked with the HR and they said that the policy was in place back in July at the renewal. It was actually a UHC error. The last person I talked to at UHC confirmed that there was an error in their computer program, giving their reps false info.

I am having my hubby look into things at work. (He works for the state, so I can only imagine the red tape we will have to work with there)

Heck, I am even thinking about changing jobs so I can go to work for someone who covers the surgery!

Thanks,

niki

Wow, that is great Cal! I think having a lawyer would help, but I am not sure I can afford it right now. I have heard that you get two appeals, and I thought I would try the first one on my own.

Sounds like we are in the same boat! Let me know what you find out, and I will do the same. Man, this shouldn't be so hard!

niki

Hey guys!

Ok, so I mourned my denial for the last month, and I am slowly getting back into the fighting mode. I know I have a battle on my hands bc the denial was due to an exclusion in our policy. My saving grace is UCH told me on 5 different occations I did have coverage! I plan to use this as my "big gun." Wish me luck!

What I was wondering is how many of you won your appeal? Anyone successful after an exclusion? And is there anywhere on this website where you can read the letters other people used to send to the insurance company?

Thanks again,

niki

DONT MAKE THE SAME MISTAKE I DID!!! A PHONE CALL IS NOT ENOUGH!!!

I know we all have had issues with our insurance companies, but my United Health Care company has truely deadened my spirit. On 4 different occasions I called to see if Lap Band surgery was covered, and 4 different people told me it was, following a medical review. I completed all of the necessary evaluations (psych, nutrition, diet history, etc) and sent the info off for review.

I called on 1/13 and was informed that it was declined for lack of coverage. I was so stunned, I just hung up the phone.

I called back on 1/15 to find out how this could have happend and was told that it was an error, and they would send it back for an urgent review.

I called back again on 1/16 and was told the review was denied again and that I do NOT have coverage. I told her about the 5 other times someone have confirmed coverage,and she said that they were not following the proper procedure in looking up obesity surgery. She told me that it is an exclusion in my policy. She gave me the address for an appeal, but told me that it was not likely they would change their minds.

Needless to say, I am completely devistated. I am not only out the $500 I have spent so far, but more importantly, struggling to think of ways to get the 15K for the surgery.

I am seeking your advice! Anyone have something like this happen to them? Was it worth the time and energy to fight the insurance company? I was told by my doctor that fighting an "exclusion" was more with your employer, and I can only imagine what that would be like. (my hubby works for state government)

I am just looking for any info you guys might have. Thanks so much for your support!

Niki

Where do I start????

1. Having energy to play with my kids again. I am so tired to just existing, I want to live again!!

2. Being able to cross my legs again! Enough said!

3. Being able to fit into my clothes again. I am tired of wearing my DH gym pants and T-shirts bc they are big enough for me! I want to feel like a woman again!!!

4. Living with good health, and teaching my kids good eating habits!

Just to be the me I have inside of myself!!!

Good luck to you! I am sure everyone in the hospital will take great care of you...pre-op and post-op!

Niki

Thanks Julie! My Hubby came home tonight and told me about the website, too. Maybe that is a good sign!

niki

Maybe you are building more muscle mass with the increased activity? It sounds likely to me!

I am sorry to hear that you are getting the run around. If I were you, I would call the insurance company directly. Get the name of each person you talk to and keep a journal!!! Take it from me, be pro-active and organized!!! Good luck to you!

niki

Hey guys!

Just wanted to update you on what I have found out. My husband got a copy of his exact coverages, and the band (GBP too) are infact an exclusion. I am not sure why the five insurance people I talked to on 5 different dates told me it was a covered benefit. I plan on using this in my appeal. The hardest part of this is knowing that I chose to use my husbands insurance bc I thought it had better band coverage. What a joke!

I have to talk to my DH and decide where to go from here. I would really love to try to get it financed and have it done soon, but I think 15K is a lot to ask of my family. (I have two small children and I only work part-time) I might end up having to wait til next Dec for open enrollment and go with my insurane company. I just can't believe this is happening!

My question for you guys is how many of you had a BMI of less than 40 when insurance aproved surgery. What were your co-morbitities? How severe where they? Even if I have to wait a year for surgery, I can't live like this. I am just afraid to lose weight and not be covered by my insurance next year. My BMI right now is 41-42, but I am not on any meds for my Blood pressure or asthma.

Thanks again for the help guys!

niki

Keep up the great work!!

I am so sorry that you have hit what you feel is a dead end! I completely understand where you are coming from. I just found out last week that the surgery is now an exclusion in my coverage, only after being told 5 times that it WAS a covered benefit.

I haven't tried to get it financed yet. I am having a hard time trying to find extra money in our monthly budget to cover a loan payment.

I am really considering looking for a new job, maybe somewhere the surgery would be covered. Is that an option for you?

Good luck to you! Hang in there and try to take it one day at a time!

niki

Thanks for the info, guys! I am having my hubby get a copy of the SPD on Monday. I will let you know what I find out! Thanks again!

niki

WOW! Great news for you!!!

Hey everyone! For weeks I have visited the site gathering info and gaining insite into life with the lap band. It has been so helpful in my decision to have a lap band placed. It seems only natural to turn to you for help with my latest brick wall.

I know we all have had issues with our insurance companies, but my United Health Care company has truely deadened my spirit. On 4 different occasions I called to see if Lap Band surgery was covered, and 4 different people told me it was, following a medical review. I completed all of the necessary evaluations (psych, nutrition, diet history, etc) and sent the info off for review.

I called on 1/13 and was informed that it was declined for lack of coverage. I was so stunned, I just hung up the phone.

I called back on 1/15 to find out how this could have happend and was told that it was an error, and they would send it back for an urgent review.

I called back again on 1/16 and was told the review was denied again and that I do NOT have coverage. I told her about the 5 other times someone have confirmed coverage,and she said that they were not following the proper procedure in looking up obesity surgery. She told me that it is an exclusion in my policy. She gave me the address for an appeal, but told me that it was not likely they would change their minds.

Needless to say, I am completely devistated. I am not only out the $500 I have spent so far, but more importantly, struggling to think of ways to get the 15K for the surgery.

I am seeking your advice! Anyone have something like this happen to them? Was it worth the time and energy to fight the insurance company? I was told by my doctor that fighting an "exclusion" was more with your employer, and I can only imagine what that would be like. (my hubby works for state government)

I am just looking for any info you guys might have. Thanks so much for your support!

Niki