DreamsOfSkinny

Good luck Heyher! I got denied 1st appeal. Opened a case with my employer saying their advocate group isn't helping resolve issues (besides just the fact of being denied), and I even called UHC Corp. HQ today and opened a ticket with them! They said it doesn't count against me as an appeal, but she'll research to find out why my UHC issues haven't been resolved and why they don't accept the NIH definition of "morbid obesity" and keep focusing on that 40 BMI (which isn't even the language in my SDP). I'm hoping between these 2 things that this can be once and for all corrected information in their system and get an approval!! Sending good thoughts your way too!!!! We need approvals

Hope you're feeling better!!

Ok.... Taking deep breaths. I'm sure many of you have read my previous posts about my UHC hell process. I'm on the phone now to find out yesterday my appeal was denied because I didn't have 5 years of weight history! Luckily after being transferred 3x's a supervisor is seeing my frustration! I'm like I've hand fed the 5 years to them. Circled all the weights and even included all of them on the cover page of fax! Ughhhh!

United Healthcare PPO ChoicePlus

Yeh I have email proof from them plus 6 recorded phone calls. :-/ That all didn't mean SH...T! So be careful. I included all the reference numbers and info I was given in my appeal so we'll see if it helps any.

So I've been having some pelvic pain and it seems from what ultrasound tech told me yesterday I have a cyst in each ovary :-( I ran about 99-100 degree fever last night and have been on 600-800mg Motrin last 2 days. Called my gyno this morning but haven't heard back yet...

So I'm on 1st level appeal now and should know an answer by 12/21! I was told different information and didn't even know what I faxed in would be an appeal... Here we go! UHC said there is a 2nd level and then external. I also requested a bariatric surgeon be on the appeals team (hoping this helps!!)

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What's your insurance classifying this as? BMI of 40 and beyond ONLY or either 40 bmi or 35+ bmi with co-morbidity (like the National Institute of Health defines it as)?? UHC is really trying to fight on this as my summary plan description states I need a BMI of 40 today (which I have) but I slso need a physician diagnosis of "morbid obese" for past 5 years and shoeing records.

. congrats!! I just knew you were ftom louisiana lol

A whole nother story lol! I won't be with the same company after about Jan. 15-20th.... ish..., So really needing this done quickly. The insurance got my 28 page of extra/new information to review from the peer to peer denial. They never even read the follow up letter from my surgeon so hoping by doing this it will be approved and we won't have to go to appeal step. I had BMI of 38.1-40.6 for last 5 years but thanks for the info.

Ohhh my BMI's were 38.1-39.8 for last 4 years. :-/

So after some help from advocacy group from work, I have a nurse case manager. The insurance corrected their BMI for me for 2012 but then said my BMI wasn't 40 for last 5 yrs. and they didn't even have the 5th year (2008). I re-faxed over the "correct" weights aka my highest for each year today to insurance and told them my weight fluctuated bc I was on medically supervised weight loss programs that obviously didn't work long-term, explained my Supplement Plan Document doesn't state I need BMI of 40+ for last 5 yrs. but a diagnosis of morbid obesity - which I have and sent letter today too- and then showed proof that National Institute of Health defines morbid obesity as 40 ORRRR 35+ 1 sever co-morbidity. I have Pseudotumor cerebri since 2008 and it's come back since I can't keep my weight down and it's directly related to obesity and also sent in documents of most other insurances an medical institutions saying Pseudotumor is a sever co-morbidity for having bariatric surgery and using bmi 35+ co-morbidity as morbid obese..... We're hoping to hear from them next week to see what they say. If denied again I think I'm go to the obesity lawyer and file appeal. :-/ Issue is I need to have the surgery within the next 6 weeks!!! Otherwise I lose my insurance.

I was thinking about them if my employer's advocate can't help me by next week....

Self funded then.... Now let me look up ERISA ---I think you called it.

That would be my step after I'd get my appeal denied I think.... State commissioner. I need to find out if self funded or not.

That's something I haven't thought about... making sure I don't pass the window of time I have to appeal-- even if the nurse case manager can't resolve my issue in time.... I think I have 30 days

WoW!! Great work. You look like a totally different person... although I'm sure you hear that a lot now. You look so much more happy and youthful-- full of energy and life!

Great!!! Progress

I have UHC and kinda on the same road as you. My plan requirements don't specifically state I need a BMI of 40 for last 5 years but a "doctor diagnosis of morbid obesity".... UHC got some info wrong on my denial letter of the right BMI's for me so I'm now fighting with an advocacy case manager from my employer. I hope to hear what the next steps are by Friday. I did not have a 6 month diet requirement. I've heard it's either 6 months of diet OR 5 years of weight history 40+. Don't rely on the CSR's.... mine couldn't tell me the specifics under my "Summary Plan Description" and I didn't find these out until AFTER I got my denial letter from UHC. It's so crazy how it works. I had called at least 10 times asking for criteria.

I haven't had surgery yet....

Everyone is VERY different.... I've found a lot has to do with the insurnance company. My Dr. said if I was with BCBS or Aetna that I would have been approved with first submission. The case manager now - through my employer - who is helping me correct clerical issues on UHC's side and other paperwork they overlooked told me to keep working on my appeal but that I probably won't need it. That was GREAT to hear today!!! Something positive in over a month! I started my journey Oct. 15th --- I think. I'm hoping to get surgery in December. If I can get approved by next week I think they can still squeeze me in. Now I need to lose 15 lbs!

'> I'm in SF!

Ty!! Yes, my Dr. Sent a follow-up note to insurance and they only say now that they never received it when my contact from work is now on my case... She said that with my co-morbidity that it should be approved without 5 yrs medical history of weight. So we'll see... Hoping to see what the ins. Response is by Friday. My contact is also getting them to answer why the ins. Has my current BMI wrong...