United Healthcare

[2bfit 62]

Hello all! I am sitting here still waiting to hear from my medical group if I have been approved for surgery or not. In the middle of my research I found a link I wanted to share. I am not sure which plans this applies to but I do know it applies to mine (check your policy). I have United Healthcare *** Sig Value Advantage (used to be Pacificare Sig Value ***). I do know that my policy allows for bariatric coverage. Hope this can help some of you out there with questions. I was originally looking into lapband but decided on the sleeve and was researching whether or not the insurance would cover it. Based on this it does.

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf

Best of luck to all of you.

Cheri

[2bfit 62]

Ok so the drama begins...again. I just called the medical group this morning and they denied me for surgery. They are stating that I do not meet the obesity requirements and that I have to have one comorbidity to qualify with a BMI of 35-39.9, that I have to consult with a registered dietician and enroll in their weight management program. Almost sounds like a standard denial letter that they send out no matter what. I called the surgeon's office and am waiting for a call back from the nurse. They have all of the records from all of the plans that I have already tried. Maybe they did not send them in with the request?

I have written an appeal letter. First off, I have a BMI of 40 and per the policy requirements no comorbidity is needed. Second, I have already had the consult with the dietician who agrees that I would be a good candidate for bariatric surgery. Third, I went to a medically supervised weight clinic for two years, belonged to a gym for 5 years and most recently tried the HCG diet.

Along with the letter I am submitting all of these records directly to the insurance company. I did call to make an appt with their weight clinic. I will jump through as many hoops as they require. I can't give up on this and I will not go away without a fight!

I am feeling so discouraged right now though. I know it's the practice of the insurance company to deny everything. But still I am hopeful that I will win. Any words of encouragement or wisdom would be greatly appreciated.

Thanks,

Cheri