ebeeze824

I was denied by UHC back on April 8,2010. I took me until July 21st to submit my appeal letter because I had to make sure I put every single detail in the document. I submitted 26 pages of information and labeled them all as exhibits. Here is a copy of the letter I submitted. My denial was overturned on August 5,2010. August 11, 2010 Dear Medical Appeals Division, I am writing this letter to appeal the United Health Care decision to deny coverage for LAP BAND Surgery. Based on the letter of denial dated April 8, 2010, this procedure was denied because “no five year medical history." According to the Benefits Department at United Health Care there is no stipulation stating you must have five consecutive years of documented weight history but only five years which I have included with this letter. As you may have based your denial on incorrect or incomplete information, I wanted to provide the following information that shows why I disagree with your denial and why I believe LAP BAND Surgery will significantly benefit my health and should be approved. At this time, my doctor Pamela Thompson believes that LAP BAND Surgery is medically necessary and is the appropriate treatment for the below mentioned health conditions. I have also included with this document a letter from Dr. Jamal Farhan stating that I meet the requirements for the Lap Band Procedure. 8/20/02- IUD removal, weight 298 lbs- see attachment A 4/6/05- Diagnosed with Extreme Obesity, Fatigue, Back Pain, weight 316 lbs, medications noted Adipex and Merida- see attachment B 5/9/05-Diagnosed with Obesity, f/u for back pain and fatigue, weight 312 lbs-see attachment C 7/10/06- Diagnosed with Obesity, weight 313 lbs- see attachment D 1/19/07-Diagnosed with Morbid Obesity weight 326 lbs, fatigue and snoring, medications Adipex and Provera - see attachment E 2/21/07-Sleep Study- see attachment F 10/23/09- Diagnosed with Morbid Obesity weight 350 lbs, BMI 54- see attachment G 1/22/10-Diagnosed with Morbid Obesity weight 354 lbs, BMI 55-referred to specialist for lap band procedure-see attachment H 2/24/10- Went in for initial consultation with Dr. Jamal Farhan at Hurley Medical Center I also have a family history of stroke, diabetes, high blood pressure in both my parents and heart attack.

Hello everyone. I just want to thank everyone who prayed for me during this time. God is a miracle worker. My appeal was approved on 8/5/10! I just found out today:thumbup: I am sitting here on the edge of the earth with excitement waiting on the surgeon's office to call me and give me a date for my surgery. OMG, I just can't believe i'm finally here.

My physician is helping me out as much as she can. She approved my letter b4 i sent it off with the documents. She just told me to stay on it because my contract only ask for five years history not five consecutive years of history. Which the UHC benefits dept suggested that I wait until 2011 to give me five years history which would be 06,07, 09,10,11 so I figured if they can take that without a 08 then they can take a 05 weight and do the procedure this year. There will never be a 2008 because I didn't go to the doctor at all during that time cause I lost my coverage when the recession hit and lost my job :bolt: so hopefully my appeal goes thru and I can get going on this

Thank you so much :biggrin:

they denied me saying i didn't have five years of documented weight history

I started on this journey back in January 2010 and I'm still on the road keeping my prayers focused on my goal. I completed all my task and requirements by the end of March so my paperwork was submited and DENIED. I was denied because United Health Care claimed that I didn't have five years of documented weight history. So I gathered up all my medical files for the last 10 years and sent them over yesterday July 21. I just need somebody other than me to pray about this decision and keep me uplifted because my hope is going down slow. What do you think of this letter? Dear Medical Appeals Division, I am writing this letter to appeal the United Health Care decision to deny coverage for LAP BAND Surgery. Based on the letter of denial dated April 8, 2010, this procedure was denied because “no five year medical history." According to the Benefits Department at United Health Care there is no stipulation stating you must have five consecutive years of documented weight history but only five years which I have included with this letter. As you may have based your denial on incorrect or incomplete information, I wanted to provide the following information that shows why I disagree with your denial and why I believe LAP BAND Surgery will significantly benefit my health and should be approved. At this time, my doctor Pamela Thompson believes that LAP BAND Surgery is medically necessary and is the appropriate treatment for the below mentioned health conditions. I have also included with this document a letter from Dr. Jamal Farhan stating that I meet the requirements for the Lap Band Procedure. 8/20/02- IUD removal, weight 298 lbs- see attachment A 4/6/05- Diagnosed with Extreme Obesity, Fatigue, Back Pain, weight 316 lbs, medications noted Adipex and Merida- see attachment B 5/9/05-Diagnosed with Obesity, f/u for back pain and fatigue, weight 312 lbs-see attachment C 7/10/06- Diagnosed with Obesity, weight 313 lbs- see attachment D 1/19/07-Diagnosed with Morbid Obesity weight 326 lbs, fatigue and snoring, medications Adipex and Provera - see attachment E 2/21/07-sleep Study- see attachment F 10/23/09- Diagnosed with Morbid Obesity weight 350 lbs, BMI 54- see attachment G 1/22/10-Diagnosed with Morbid Obesity weight 354 lbs, BMI 55-referred to specialist for lap band procedure-see attachment H 2/24/10- Went in for initial consultation with Dr. Jamal Farhan at Hurley Medical Center I also have a family history of stroke, diabetes, high blood pressure in both my parents and heart attack. Based on this information, I am asking that you reconsider the denial and approve coverage for LAP BAND Surgery. My doctor has estimated a scheduled surgery date for September 1, 2010. If you need any additional information, please contact me Do you think this letter is effective at all?

if your nephew is anything like my bad butt nephew he knows exactly what he is doing. mine just recently turned six and believe me he calls me Big Momma and always wants to lift my shirt up to see his auntie's fat belly..........go figure is mother is about 120 soaking wet....... keep trying with the insurance company and with the human resources department at work you may get a blessing in disguise without even knowing it

My requirements through UHC was over 21 years old the BMI requirement as your plan 5 years of documented weight history and in network surgeon and hospital Now with that being said........I met all the requirements however i was denied. waiting on a decision for my appeal

:thumbup:Congrats on your approval

working on it

I was denied by UHC because I didn't have medical insurance in 2008 so I didnt' see a physician. However, UHC encouraged me to wait until 2011. It took me about a week for this decision. UHC is really quick about it so you may have some results by the end of the week.

talk to her in a calm way about the situation and then pray about it.

Congrats to and sending prayers in your direction.

Congrats to you! I dont know how you feel about religion but just pray before you go and leave it at the door God will see you through it.

I am starting the appeal process to UHC who denied my first request for the LAP-BAND®® because I was missing one year of medical records for my five year requirement. I dont have a record for that year because I was unemployed and had no insurance to cover me medically. Other than that I had all my other requirements taken care of. Is there a template I should use for writing this appeal. Please help cause I'm highly frustrated sitting in my office crying cause I really dont know what to about this. Thanks so much

Congrats to you:thumbup: