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Call your insurance company and ask if WLS is covered then ask them for the exact wording of the requirements. I have choice plus as well. If it's like mine, I can help you by telling you what I did...

Well, I'm very weak from the swine flu. It's the second week. The sickness part is gone but I have NO ENERGY!! I had a little more energy today. I didn't have to stop but twice on the way in from the parking lot to the office this morning. I do not want to have surgery until I get my energy back. I called the doctors office and asked them if they had been notified by UHC that I was approved. The ins. cleck said she had been very busy and didn't know. She said why don't you fax what you have. I did that today. I didn't hear anything from them. Clearly, they must have a LOT of patients because I'm not a priority. I wonder if I ever called them again if they would care. Oh well... I need to concentrate on getting better and I would like to find a support group in my town. I have been so consumed with working on the ins. appeal that I'm afraid I've forgot everything I knew about how to eat after surgery. I want to research that and find a protein shake I can drink and get some things in the house that will be OK to eat. With the Swine Flu, I lost over 11 pounds in a week. It was a really bad way to loose but they're gone just the same. I'm working hard to eat right and keep this weight off. I'm tired so I'm closing. Hope you are doing well!! :thumbup:

Well, I'm very weak from the swine flu. It's the second week. The sickness part is gone but I have NO ENERGY!! I had a little more energy today. I didn't have to stop but twice on the way in from the parking lot to the office this morning. I do not want to have surgery until I get my energy back. I called the doctors office and asked them if they had been notified by UHC that I was approved. The ins. cleck said she had been very busy and didn't know. She said why don't you fax what you have. I did that today. I didn't hear anything from them. Clearly, they must have a LOT of patients because I'm not a priority. I wonder if I ever called them again if they would care. Oh well... I need to concentrate on getting better and I would like to find a support group in my town. I have been so consumed with working on the ins. appeal that I'm afraid I've forgot everything I knew about how to eat after surgery. I want to research that and find a protein shake I can drink and get some things in the house that will be OK to eat. With the Swine Flu, I lost over 11 pounds in a week. It was a really bad way to loose but they're gone just the same. I'm working hard to eat right and keep this weight off. I'm tired so I'm closing. Hope you are doing well!! :tt1:

I'm approved... finally. I've had the swine flue so it's been rough this week.. I finally have something to smile about!! :huh2::tt1:

I'm approved... finally. I've had the swine flue so it's been rough this week.. I finally have something to smile about!! :tt1:

They have had the appeal for ten days. I should hear something back on the 17th. I'm holding my breath!! The denial said they needed "a diagnosis of morbid obesity of over five years" I sent in a letter from my PCP I was a page type written from my PCP outlining all the things he was treating me for and the times I had been treated for weight control.. and a sentence saying I had been morbid obese for over five years.. I'm hoping that will surfice. I have no way of knowing what they are reallying looking for... Oh well... I am so hoping the wait is almost over!!

OK.. I work for AT&T as well. Please post if either of you get approved. I've working through an appeal now.

I sure did. My PCP was supposed to have sent a letter outlining my co-morbiities. He had sent one letter saying I had to have thyroid surgery. I thought they had gotten the second letter.. which would have provided the "five year diagnosis of morbid obesity" which UHC requires.. I told the ins clerk the requirements.. It wasn't until the appeal that I asked the surgeon's office to make a copy of everything they sent the insurance company that I realized what was missing. I'm still in the appeal and hope I have given the insurance everything but I may still get something saying they need something else.. I should know something by the 17th. I wish UHC would tell me what else they need BEFORE they deny me so I would have the opportunity to provide the info BEFORE the denial.

I beleive they were dragging their feet to make sure you had to pay the deductable..

Thank you for the kind words. My surgeon sent in an appeal. I am waiting to hear what they say. I have sent off for the wording on my plan (just in case.) I'm going the Obesity Law if this doesn't work. With high blood pressure, type II diabeties, GERD, incontinence I know I would benefit from having this surgery. I hope UHC does the right thing..

Becky Lou, How is the fight going? Are you getting anywhere?

They did not say it had to be five years in a row. It dawned on me last night that I could probably go back to prior years.. I would love to see the letter you used. My email is necholeheadley@gmail.com Anything you can send is greatly appreciated...

I am working on an appeal with UHC. Does anyone have a sample of a letter from the PCP diagnosising morbid over a minimum of five years? I need to send something to my doctor showing him sort of what I need it to say..

I work for AT&T and was turned down. I do have documented co mobities. I had four years BMI over 40 and one year 35.7.. They said flat you have to have all years over 40... I am appealing. Any info any one has would be greatly appreciated. KingsFan I would be interested in knowing if you are approved.. and if you had the five years BMI

I work with AT&T on east coast. I was told my UHC i hae to have five year weight history from physician bmi over 40 period. I did not have all five years.. They denied me. Nothing in Appeal said they would approve surgery if I have comorbidities. I documentment them. I had four BMI's over fourty and one at 35.7 when I was taking diet pills. I'm trying to appeal. If ANYONE has a simular situation and was successful I would love to hear from you..

RickyRoss831, I have UHC insurance and had only one year under 40bmi and I got denied. Did you ever get your approval and if you did.. how? Nechole

Please keep me informed as to your progress...

You can appeal I have read a lot about appealing. I sent you my email. I would like to talk with you. Also. What is HTN. ???

Becky Lou, I haven't heard anything yet. My insurance required five years 40 BMI (like yours) or higher OR doctor statement saying surgery is a medical necessity. I thought the doctors letter was sent in on the original request because I thought everyone understood what the ins required and what my BMI's were. We did discuss this. But... The letter was not sent in UNTIL the insurance denied the surgery and then the ins clerk sent it in as an appeal so she waisted one of my appeals. I feel like the doctors office let me down on this one. The ins company said it would take between 15 to 30 days for a ruling on the appeal. This is day three. I am hoping so much that it doesn't take even 15 days. This is torture!!! Please keep me informed as well. Sounds like you and I are in the same boat... I have High Blood Pressure on meds runs about 158/84. GERD. Really bad joint pain that I will have to do something about if I don't loose weight. I have sleep disturbances. weak bladder. Really bad Asthma. Shortness of breath. depression. I also wrote my own letter to the insurance company outlining why I thought the surgery was medically necessary and letting them know of the diabetics that run in my family and how my dad died at age 59 of congestive heart failure and the illnesses and surgeries that my Mom is having. I explained how spending the money on this surgery would save money on joint replacements. I don't know if this will help or not but I wanted them to see that I am a real person not just a file and that this will improve my quality of life.

I was denied today.. BAD NEWS!!!! My UHC does cover the surgery with BMI OVER 40 with five year weight history. I had 4 BMI over 40 and one year at 35.5 (when I took diet pills.) I do have high blood pressure and Acid reflux but I was still denied. The doctor is going to write a letter stating this is medically needed and Lori is going to fax it to them tomorrow. I am wondering if this will be enough...

I was denied today.. :sad: BAD NEWS!!!! My UHC does cover the surgery with BMI OVER 40 with five year weight history. I had 4 BMI over 40 and one year at 35.5 (when I took diet pills.) I do have high blood pressure and Acid reflux but I was still denied. The doctor is going to write a letter stating this is medically needed and Lori is going to fax it to them tomorrow. I am wondering if this will be enough...

What I can tell you is that every employers policy with UHC is different. Mine requires the 5 year over 40 bmi or 35 with comorbities such as high blood pressure among others. My doctors office just sent in all mine info. All BMIj's were over 40 except ONE year and that year was 35.5 BMI. Since I had the high blood pressure and Gerd, Asthma I thought I would be approved with no problem. But I received word today that I was denied. My doctor is going to send a letter of medical necessity tomorrow and hopefully that will work. I am going to start researching and working on an official appeal tonight. I feel like UHC have approved others just like me and yet they still are doing everything possible to delay or deny the claim. I feel like I qualify based on the criterea and I feel like I need this surgery for health reasons. I'm not going to give up.

Well the doctors office hear from UHC today and I was denied for not having five years over 40 BMI. One year I was 188 which meant I was 35.5 BMI. (This was when I was taking diet pills. I have comorbities which should make me elgible with 35. I called UHC and they told me to have the doctor to send a fax letter of medical necessity with explanations. All my comorbities were listed in the initial info sent to UHC so this is just a ploy on their part to slow the process and discourage me. This won't work. The doctors office will send the letter tomorrow they say. In the mean time, I will start researching to see what my options are and if there are peole that can help me. This is just yet another hurdle I have to jump through. I will not stop until all my appeals are exhausted and it this letter doesn't work the next appeal will be well thought out and documented.

Kamekar25, I know just how you feel... the last week I've been on vacation.. The beach helped so much take some of the edge off the wait. I still thought of it everyday but it was much better. Now that I'm back home.. I'm hoping I will hear somehting next week. I plan to call UHC first thing Monday. I hope I hear something next week but I'm thinking it will be two more weeks. I guess they will take the whole thirty days..

Still waiting.. Ive been on vacation.. sorry for the delay in answering. I'm still waiting. It will be two weeks this Tuesday. I've called several times and UHC says everything is pending.. One of the reps said they had ten days but the last one I spoke with said they have thirty days.. who knows.. I guess they are going to take all thirty days...