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APPROVED FOR SURGERY!



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After months of waiting I found out today that United Healthcare overturned the medical groups decision that denied my surgery! I am finally approved. I am so flustered right now I can't even think straight! I started this process back in July. My BMI was only 39 and I was denied for the consult because I did not have a qualifying comorb. In Sept I went back to my PCP and my BMI was 41. I was denied for the consult stating I needed to show motivated attempts for dieting for 6 months. I submitted the medically supervised weight loss program I was on for 2 years and was finally approved for the consult. Then the surgeon requested the surgery and I was denied citing I needed to have a BMI of 35> with one qualifying comorb. Problem was they were quoting a Medicare plan and not my specific evidence of coverage. I appealed and today I won! BIG HAPPY DANCE! :)

I have an appointment to have my pre-op paperwork with my PCP on Thursday. I will have to request a referral for a psych eval at that time. Tomorrow I meet with the NUT for the 2nd visit and will only have one left after that. They are going to require labs, ekg, chest xray and a medical clearance from my doctor as well. I am hoping to get all of this done so that I can have surgery at the end of this month! Wish me luck!

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Congats and Good Luck! i am waiting also!

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Which UHC you have I have the Govt nyship?

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I have United Healthcare H M O Signature Value Advantage in So Cal. Thank you for the good wishes. Be your own best advocate because they are hoping that you will go away. Get all of your paperwork in order before submitting for approval. Try to get as much documentation together as possible!

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Congratulations!! I'm so happy for you!

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OMG good luck I am so happy for you ! I cant wait for mine I pray and pray!

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I just got call uhc has my papers and its good they said they sent it to cob i am so so happy I should know by Friday!!!

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hang in there! :)

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I was denied by UHC PPO - I am a band to sleeve revision. I was approved for my Lapband to be removed but not for the sleeve since they said I didn't have the 6 months pre-op supervised diet. That is such a crock because living with a Band for 5+ years restricted my calories and I went through the whole process way back then for WLS. In any case, I just sent in my Appeal Letter on Tuesday and should hear in a couple of weeks so I appreciate prayers and positive thoughts from those who have gone through this before.

Just wondering if those of you with UHC were denied through Optum Health - seems they use them for their Medical Reviews. The people there were nice and understanding on the phone and really encouraged me to Appeal so I hope that's what it takes. Silly me I really went into this thinking that if they approved the Lapband removal there was no way they wouldn't approve the revision to the Sleeve. I started the pre-Op diet after being denied right away as a back up plan so worst case I hope to be fully approved by mid February.

2bfit - Congrats! So happy you were approved.

Raquel - I hope you hear the same news on Friday - keep us posted.

Thanks.

Susie

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that just stinks! Why in the world would they require a 6 month diet? Good move on starting one now. I hope that they overturn your appeal. You just never know with the insurance companies. Sometimes you get people who know what they are doing and then other times you get those that really should not be involved with the medical field.

I have heard of people getting approved if there are complications with the band. Do you have any that can help with your appeal?

As for me,I am trying my best to get a hold of a psychologist to schedule an appt. It is turning out to be a challenge. I have left messages with 3 different places. So whoever calls back first is going to be who I see!

Hang in there and keep us posted. Look under the revision forum on this website and see if anybody can give you an idea of how they got approved. I know someone there can definitely help you!

Cheri

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
      · 0 replies
      1. This update has no replies.
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