Gardnergirl2

You go girl!!

Thank you ladies. I just want people to be aware that employers have a summary plan description, and thatis really the " bible" of what's covered

Hi! I just wanted to remind everyone that it depends on your employer. For example, two people can have united health care, but have totally different plans, even if its in the sae state, etc. is your employer self insured? ( they just pay uhc to administer the plan)? That makes a difference. If your employer provides you with a benefits advocate ( growing in popularity) that person can be very helpful Also, ask your employer ( or spouses if covered through spouse) for a copy ( electronic copy preferably ) of the SPD ( summary plan description) of your particular plan. That way, you can find the requirements yourself and use segments from the SPD should an appeal be necessary. Again, if your employer offers a benefits advocate, they deal with stuff all the time and can be helpful ( I am one for a major US corporation) . You never know when your denial can be based on something as simple as the wrong CPT code etc.... Or many times, you the insured gets a denial letter bc " additional information needed". Simply contact your insurance company and ask what info? Write down exactly what they say, write down date and time, as well as name of rep spoken with, then call your provider and ask them to resubmit with the exact information required. Again, if your employer provides someone like me, use them......they deal with insurance all day everyday and its their job to help you.....for me, it's also my pleasure

It would probably be very expensive. During open enrollment, can you sign up for a wls rider? Is your company self insured? In other words, do they just ay someone to administer the pan? If so, you may can appeal through your company for an exception. Do you have anyone in the benefits department that is supposed to advocate for employees? This person can guide you in what to do...just some questions for thought.

Doctors hate peer to peer reviews, but they are required many times. It's not abnormal. It's simply where the doctor at the insurance company talks with your doctor to determine the necessity of the surgery. Usually, if all goes well, a decision can come retry quickly after that ( at least in my experience)

I know I won't be able to lift heavy objects for at least 6-8 weeks or is it forever? I have a children's inflatable business, so on weekends I do have to roll and get 250-300 pound bouncies in a trailer. I know I will be out of commission for a while, but will I never be able to lift heavy stuff again? Thanks everyone. I finally have insurance that will pay for it!!

It not only depends on what insurer, but your company may have their own agreement with uhc. Ask for a copy of your SPD ( summary plan description ) and you ll have your plan specific info.

If you have a benefits advocate or liaison, do at least talk with that person. They may be able to help ( I am an advocate with a major corporation ). I would do that before giving up.

Thank. You! I can't tell you how excited I am. I have a bmi of 37but sleep apnea score of 23 and my insurance requires a 15. It's a shame to be happy to have sleep apnea, but right now I am. I have battled me weight my entire life ( was put on a diet as a baby ). I weigh 230 right now. 150 would be soooooooo nice!!