Melisa1

yeah my husband is trying to calm me down right now. He is telling me that it might vary by employer too. I just dont understand why when i call them they are telling me no that all i have to have is a letter of pre determination and then im hearing this 5 year bmi stuff. makes me crazy! lol all i can do is hope for the best at this point. makes me exhausted thinking about it.

so did you end up just paying out of you pocket? What about them telling me over the phone that i dont have to have that? I specificly asked them that question and they have told me no.? The lady in the office said to document it becuase she has known of cases overturned because of documentation. I just cant believe that they wouldnt state that in the policy if that were the case?? Do you know if that was stated anywhere in your policy?

Thank you ....im trying. Do you think the fact that ive asked them that direct question several times on the phone and documented dates i have a chance or could that be stated somewhere where i havent read? Someone told me they have to state that in your policy if thats the case?? Do you know?

OH AND....everytime i call my insurance....i ask them if i have to have 5 years of a bmi over 40 and they all say no. They said it doesnt state that in my policy at all!!! Ive documented everything too.?? We cant find it in writing and all they are telling us is it is for "morbid obesity and we have a pre determination letter from the Dr.??

omg dont scare me like that lol....my weight has fluctuated and my bmi has been under forty up and down up and down. its been more like 38-39-38-40 and now its been forty lately. I dont have any co-morbidities except for gastro esophical reflux disease (gerd) which i dont even know if its a true co-morbidity? However, besides the gerd i have arthritis in my right hip, depression/stess anxiety, stress incontience, and asthma symptoms lately. My PCP wrote and "excellent" letter of pre determination too. He thinks this would be the BEST tool for me to prevent diabetes since my dad already had it at my age!! Do you even think i have a fighting chance??

bjblev its UHC choice plus...thank you very much for helping!!!!

I have UHC choice plus. Everytime ive called they say its not coverd except for morbid obesity. Ive documented it twice now. But when we look in all our paperwork we cant find it.

Im soo frustrated with my insurance right now i could scream!:frown: Ive called them about 6 times now and they say the same thing every time. They say they cover for morbid obesity only. ok...so yes im morbidy obese! ok so i wanted to find that in writing. I searched through all the papers and couldnt find anything talking about bariatric surgery or weight loss surgery. It does state that it doesnt cover weightloss programs???? What the heck?? But everytime i call they tell me its covered for morbid obesity. Ive gotten the booklet from my husbands HR department and it states nothing about WLS. What should i do? They are telling me something i cannnot find anywhere. And ive asked them to send me something in writing and they wont? Anyone know anything or have words of experience or advice for me?? I need it.:thumbup:

I have UHC choice plus and im dying to know if they will approve me. My BMI is right at 40.1. Im 230lbs and 5'3" and should weigh like between 113-135 according to ww. so im 100 lbs over weight!! The only thing is i dont have any co morbidities. I have gerd, depression, arthritis in my hip, and back pain but no "co-morbidities" like high blood pressure, diabetes or sleep apnea. does anyone thinik i have a chance?? Im soo sick of being fat i cant stand it.

It depends on how close you are to them. If they are close friends of yours that you work with...share and tell them you really need their support and encouragement. If you guys arent really friends and you feel tension in the air at work...dont tell...its none of their business. Thats just my personal opinion. good luck.

thank you soo much. every little bit of help makes a big difference. :tt1:

asap!!! dont give up!

Thanks guys!!!!

Hi guys....hey does anyone have a sample letter for insurance i can take a look at? I have UHC Choice plus. Ive been hearing different things so i am hoping and praying i get approved. Just incase i dont, id like to have a letter prepaired for appeal. any infor or suggestions would greatly be appreciated.

Does anyone have a sample letter i could look at for insurance? I have one but id like to look at others out there that helped with approval. Thank You very much! melisa1@verizon.net

CaydensMa~did you get approval yet. Im hoping i get approved, however my bmi is 40 and i have no comorbidities i have now idea if they will approve me. I have UHC preferred plus. Throughout my five year history it has fluctuated under 40bmi so i dont know?

acadiamom~please please let me know how it turns out for you...im dealing with UHC too and getting ready to submitt my stuff. Could i get an example letter from you if possible?

So dont send them my 5 year history? The surgeons office required me to fax them my five year history. Then they said i wouldnt qualify because my bmi hasnt been over 40 for five years straight?? SO thien i called my insurance myself and actually ive called and asked 6 times. not one person found anything in my policy that stated that i had to have a 5 year history of a bmi over 40!!!! what the heck? Im so confused at why the office would tell me that before they even submit to my insurance.?

WOW THATS WONDERFUL. I sure hope i have the same luck. Im 230 lbs, 5'3". My bmi is at 40.1. I have gerd but ive heard different things about it being a co morbidity.? Do you know if bladder problems are considered a co morbidity? I also have had back problems for years which is documented in my history. But i have no high bp, no diabetes, and no sleep apnea. ?:sad:

yes...omg i would love to have a copy of the letter to help me in any way possible. My e-mail address is melisa1@verizon.net. Thank you soooo much! I appreciate that!

NO WAY!!! NOW that is INSANE! Dont give up!! Best wishes to you!!

thank you!!! I will try. I cant even believe the office didnt even encourage me to try anyways?? especially after all ive been through! I just left a message for them to call me back.

Hi guys...i dont know if im in the right place to ask this question but...I have UHC ppo. They cover 90% for bariatric surgery. Ive done all my testing. sleep study, ekg, blood, urin, chest xray and endoscopy. Then "today" my surgeons office tells me that i have to have a five year history of having a bmi over 40 or two co morbidities. First of all...why didnt they tell me this at the beginning? and second is this stated in my policy? they flat out told me all of a sudden that it wont be approved by my insurance? This is such a slap in the face. Ive been over weight all my life, my bmi is 40 and i weigh 230 lbs. 5'3". Yes my weight has dropped 5-10 lbs up and down forever but COME ON. thats rediculous! Does anyone have any recommendations or ideas, answers, hope?? __________________ Melisa:thumbup:

Im going through the same thing!!! I just had all my test done: ekg, chest xray, sleep study, blood, urine and endoscopy!!! THEN the office said they were looking through my history and my bmi hasnt been ovr 40 for 5 years!!! WHAT THE HECK??? why did i go through all of this to hear that?? Is this stated in my policy? im soo depressed, upset, everything!!! I just called the office to see if i have sleep apnea. I was just diag with gerd, i have pre arthritis in my right hip, back problems, and problems wth bladder!!! omg! what the heck. any advice anyone? The office is acting like they arent even going to submitt it to the insurance because they know it will be denied???? what do i do?

Hi guys...i dont know if im in the right place to ask this question but...I have UHC ppo. They cover 90% for bariatric surgery. Ive done all my testing. sleep study, ekg, blood, urin, chest xray and endoscopy. Then "today" my surgeons office tells me that i have to have a five year history of having a bmi over 40 or two co morbidities. First of all...why didnt they tell me this at the beginning? and second is this stated in my policy? they flat out told me all of a sudden that it wont be approved by my insurance? This is such a slap in the face. Ive been over weight all my life, my bmi is 40 and i weigh 230 lbs. 5'3". Yes my weight has dropped 5-10 lbs up and down forever but COME ON. thats rediculous! Does anyone have any recommendations or ideas, answers, hope?? __________________ Melisa:thumbup: