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casenior

Pre Op
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Posts posted by casenior

  12. Posted

    I'm trying to get a revision procedure so I was initially denied due to not having 5 years 40 bmi. But my case is I had a procedure in place 5 years ago which explains why I only have 3 years. I'm praying my surgeon can overturn UHC's denial thru the peer to peer next week. It's giving me so much anxiety and depression right now

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    Have you gotten an update?

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    I was denied in the peer to peer as well so now it's on to appeals

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  14. Posted

    My nutritionist has had me on a pro-biotic since my pre-op diet. I was allowed to take pills at 7 days post-op, so I did have a brief period beginning the day before my surgery until 7 days post op where I didn't take it. I would suggest discussing the situation with your surgeon to find out what the best solution for you specifically would be,

    Thank you!

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  24. Posted

    peer-to-peer for next Tuesday. She said 9/10 times the "medical director" that reviews the requests is a primary care physician and they don't fully review everything submitted, they just look to see if you satisfy the eligibility requirements. So she is confident my surgeon can get them to overturn the decision.

    I don't have your experience, but am stopping to throw out a couple of thoughts.

    Maybe I'm missing something here. If the reviewer looks at the paperwork only to see if you meet the eligibility requirements (minimum 40 BMI for 5 yrs and 21+, as you report), it seems that you'll be rejected again. Wouldn't that mean it's likely that the initial denial will stand?

    . I had to have it removed and by 2013 was back up to my pre-op weight of 255.

    Last week UHC denied my request for the sleeve because I don't have 5 years of a 40 bmi.. Despite my doctors notes that I had another procedure in place in the beginning which was why I don't have 5 years.

    It certainly won't hurt your peer-to-peer procedure if you supply letters in support of sleeve surgery from any and every doctor you can. These letters aren't about explaining why you don't have the required five years, but rather to state all the medical reasons you need to lose gobs of weight, all sorts of health and physical problems that are dangerous and can be solved by weight loss. If you do have doctors who can whip out brief letters, you need to move fast so that your insurance coordinator can get them to the peer review people. It can't hurt your case.

    If the process fails, you may choose to go to the next stage of appeal, whatever it is. I don't have personal knowledge of them, but there is a law firm that works on these things. If you'd want to consult, the head's is Walter Lindstrom.

    If worse runs to worst, would you be covered if you wait until you have 5 years of 40BMI? Would you be covered despite the earlier surgery? Just tossing out questions in case they haven't occurred to you.

    Good luck.

    Yes I'd be covered but I have other health issues right now that I need the procedure for.. And I work in oil and gas and chances are we will see more layoffs.

    My doctor should be able to justify that this is a revision of the failed procedure UHC covered me for before. That I have health issues now that would greatly be reversed through the weight loss. If I went in today to have my lapband removed, UHC would cover a revision. Hands down, no questions asked.

    My surgeon has had success in overturning their decision before and the care coordination rep I spoke with at UHC said that she sees the initial denials get overturned all the time especially for someone in my position.

    The peer to peer is a chance for my surgeon to sit down with the UHC medical director and clearly state the facts and fight for approval. If that fails the next step is appeals and that's where I would get any and all supporting documentation from my other physicians.

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  25. Posted · Edited by casenior

    I cancelled once before as well. But I started getting sick all the time and realized my health was way more important. I know 5 people in my life personally that have the sleeve and not a single one of them has issues with being sick. Not a single one regrets it & not a single one has had any issues post-op. They love their sleeves and have had major success. Not to mention I'm in a fb support group of over 80 sleevers and same applies to them too. Do what is right for you! :)

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