spectacularone

Oh that would be AWFUL! I hope you get aproved for real! My husband's emplyer is now involved and that has really seemed to help get to the bottom of this issue with UHC. I'm waiting to hear but there's a chance I may only be approved for gastric bypass NOT the lap band. Hmmmm.....not sure what I'd do then.

It IS over 40 now! I've waited so long and have just been gaining on not really on purpose but because I didn't want to diet and disqualify! The person at UHC also said that the surgery center was not in network and that may have caused some confusion so I think I'm going to go to another center that is in network and resubmit. It's weird because I'm appealing the denial (with the attorney) and resubmitting in two different actions at the same time. Time will tell how this will play out. So, Violeteyes, you finally got approved right? That's awesome. I will not give up!

Okay, this is NUTS! I just called my husband's employer. They were so nice and helpful. They called UHC for me and waited on hold and they stuck up for me. Then in the end UHC said they never received the paperwork from my Dr's office! Can you beleive that? After waiting over 3 months and having been denied by UHC--they are saying it's because they didn't get the paperwork. They have never mentioned that the other 100 times I've called. I swear I've heard it all. I'm going to resubmit and start over. Wish me luck! This is crazy.

As you posted this--I contacted them and guess what? They are going to send me a letter in 10 business days. I want to cry--that's 3 more weeks! My attorney can't draft an appeal without the information. Why is everything 3 weeks? This is the most maddening thing I've ever been through. I haven't had to deal with insurance companies much in the past but UHC sucks--I mean their people have ZERO knowledge of anything you ask. I mean they know nothing. I did try to call my husband's employer and they sent out a 100 page coverage detail that states surgery is covered "when deemed to be medically neccesary". But, no details. I guess I just sit and wait and wait and wait.

After being denied by UHC on February 2, I've gotten an attorney to assist with my appeal. Now, I'm waiting on them to write the appeal, which I guess can take two weeks and then UHC has an additional two weeks to say if they will overturn the denial. This is taking forever and I'm a very on top of things person. I've gained weight while I'm waiting and I'm having a sleep study. Does anyone know--once you go through the appeals process and if you lose, can you go back and try to get it approved again in a few months or are you done for the year or what? Our insurance policy says it covers it but where on earth do you find the requirements--like 6 months diet or any of that? UHC is so clueless, they have no idea and I've called my husband's HR. How can you find out what the criteria are so that you can meet them?

Has anyone hired either of the two attorneys that specialize in Obesity related insurance appeals? I would just like to hear some other experience on this matter. I was denied by UHC on 01/23 and am waiting for my medical records and highly considering hiring an attorney.

They can be RUDE! One girl told me I was "lucky" they covered this proceedure at all since it's totally elective. I should've reported her but didn't have another 30 minutes to be on hold that day. My husband works for Chase so it's not federal but we chose this insurance BECAUSE surgery was covered if "medically neccesary" then to get declined with no reason sated was a shock. Like you--each time I called I was assured that it was covered and it wouldn't be a problem. One day they told me since it was out patient that I didn't need approval at all! Then BAM, denial letter in the mail. I hope this attorney can make some sense of this. I started all this in December and have stayed on top of it and I still don't have any real answers.

anybody have any idea how long the attorneys take to put the appeal together?

I was denied by UHC Choice Plus with a 38 BMI and no real co morb. except sleep apnea, but no sleep study. Our plan clearly states that it's a covered benefit "when medically neccesary" and that's the trick--figuring out what some "review panel" beleives to be medically neccesary. I am in the process of appealing now with one of the attorney's. It did take 30 days for them to send out a denial letter. Here's what stinks about UHC is each time I called I got a different answer or told to call back in two weeks! My denial letter was VERY vague. Not deemed medically neccesary but no reason why it's not deemed medically neccesary. Just that sentance and no more. After all that I had to order my complete medical records and THAT took 30 days and get a copy of my insurance handbook from my husband's employer another 10 days and then hand all of this over to the attorney and who knows how long that'll take. I REALLY wanted to be thinner for summer. If this doesn't work out, I'm going to fly to Denver and have it done by Dr. K ($9950) and pay cash. My husband is just very concerned that if I have complications heaven forbid that it would wipe us out financially. That's my main concern and why I'm fighting so hard to get it covered. I've read about people on here who turn right around after being denied and resubmit and then get approved? I wonder if I should try that if this appeal doesn't work.

I waited 30 days and then got denied by UHC. But, they sent mine to the wrong department. I am in the process of appealing now. But, I was never given a reason for denial. I know my plan covers it but they didn't tell me what I was lacking to qualify. So, I had to get an attorney and I hope they can make sense of it. If I had it to do over, I'd get a copy of my "plan booklet" and find out what they were looking for BEFORE I submitted it. I had to call my husband's work and request one, UHC doesn't give them out because they are different from employer to employer. I am concerned about the 5 years of BMI over 35. I don't have that. The diets I have tried would work and then I'd gain it back so I have weights in the last 5 years that are under 35. If you lose an appeal can you just go and apply again? I read somewhere on here that this girl applied 3 times in 4 months and eventually they said yes. Is that the case? Seems like they'd just see that you just appealed and deny you right off the bat. I may need to build my case better next time. I haven't been formally diagnosed with any major health problems either and I'm only a 38 BMI.

Lindstroms have taken my case for FREE due to the Inamed funding thing so I guess that it's true. I will see how far they get. So far they take a couple days to return an email/phone call. But, having come from a legal background I have found that to be true with almost every good attorney (they don't have time to sit and answer emails all day). The proof will be in the results. I have built quite a case myself with 5 years diet history (I can't beleive I found all those receipts and weigh ins), all my previous prescription records from 6+years (fen-fen, meridia), primary care physicians records etc. I do have one concern: someone mentioned that you may have to have been a 35 BMI for at least 5 years? That I don't have. I did lose weight on diets of course I gained it all back. But, I for sure have some weights that are below 35.

I mentioned this earlier but UHC once told me to go ahead and have the lap band--that because it was outpatient I didn't need approval. Then two days later I got a denial letter. We're appealing but I swear I've never seen a insurance company so inconsistant.

I don't think the surgeon pays for the attorney. It was Lindstrom himself that told me there was a program that would pay for his fees. I haven't been "approved" yet to have the legal fees paid for. I have applied and my Dr.'s office said it's through the lap band maker inamed?? Anyway, I don't beleive anything until I see it. I'd be willing to pay for the attorney if I need to. I think it's so awesome that there are people that are going through exactly what I am--it's nice to gain insight and support. Thanks Jellybelly for you words of support and I'll hope for a good outcome for you as well.

Waiting is the hardest part. Waiting on my medical records to give to the attorney who's going to file an appeal on my behalf. I've really lost faith in United Healthcare and don't really beleive anything they say. I'm hoping the attorney will be the one to deal with them from now on. I just pray and pray that my denial gets overturned. I wish I'd have read all of this information BEFORE I turned in my first predetermination--maybe I wouldn't have gotten turned down. Keep your fingers crossed for me!

I got a form from my surgeon to apply for a FREE attorney (Walter Lindstrom)to assist with the appeal! I would've paid for one but free is even better. I'm a pessimist so we'll see if it is truly free and how well it works. I am 38 BMI with United Healthcare and got turned down flat with no explaination in the denial letter. It is a covered benefit under my husband's plan. I have never prayed so much in my life for something! My husband and I decided that if I can't get insurance to pay for it, I can't do it. Even though I could charge the operation, I'm more afriad of complicaitons. The thought of complications wiping out our savings (we have 3 kids) is just too risky for us. Waiting on this process has been overwhelming. It's really all I think of--am I going crazy?

We had a choice of which insurance provider to select with my husband's work. I picked United Health Care because they specifically cover lap band surgery for those with a BMI of over 35. Well, we submitted a pre determination and after 20 days or so, I started to call and check on the status. Each and every day I called they said something COMPLETELY different! One day they said to go ahead and have the surgery since it's outpatient I didn't need pre determination. The next day, they said it was in medical review. Then I finally got a denial letter in the mail that had NO reason stated for the denial! We (my physician and I) are appealing and I'm going through all the hoops of getting my medical records--they said that alone could take 30 days and then another 15 to hear about the appeal and 3 weeks after that for the actual surgery.......this is going to take FOREVER! It's hard to be patient here:)