So got the denial because I don't have 5+ years of BMI of 40+. I am an excellent candidate for surgery and I can't sit around waiting for the next few years for my health to decline so I have the 5+ years. With my multiple sclorosis and reconstructive knee surgery that would just be cruel. So surgeon is going to do a peer to peer with the medical director and if that still doesn't work we move to making a plea to my company to allow an exception in this case because of the additional health risk with the obesity, ms, and reconstructed knee.

So got the denial because I don't have 5+ years of BMI of 40+. I am an excellent candidate for surgery and I can't sit around waiting for the next few years for my health to decline so I have the 5+ years. With my multiple sclorosis and reconstructive knee surgery that would just be cruel. So surgeon is going to do a peer to peer with the medical director and if that still doesn't work we move to making a plea to my company to allow an exception in this case because of the additional health risk with the obesity, ms, and reconstructed knee.

Hi,

I've heard that the peer review often works to get the decision reversed. I'm keeping my fingers crossed for you.

By the way, I have MS too.....one of my goals for losing weight is to help with the overwhelming fatigue....

got the denial because I don't have 5+ years of BMI of 40+. surgeon is going to do a peer to peer with the medical director and if that still doesn't work we move to making a plea to my company to allow an exception in this case because of the additional health risk with the obesity, ms, and reconstructed knee.

Heyher

i am glad the surgeon is in your corner

hopefully all his help/input will be successful

good luck

Sorry to hear about your delay... I say delay because it looks like your surgeon is going to go to bat for you to make this happen. So I am visualizing a happy outcome for you. Sending you positive thoughts and wishes for the best possible outcome. Good luck to you.

I hope everything works out for you on this route. But know that self-pay is also an option. My insurance didn't cover any form of bariatric surgery, but I knew the consequences of my obesity were ravaging my health. I took a second mortgage on the home (some places offer financing) and plopped $10,400 to have it done in Vegas (baby!). Had a wonderful experience there and my restriction is still awesome.

While that is a lot of money out of pocket, I was able to itemize it on my taxes and I know my healthcare expenses over the past year have been reduced because of it. Also, my food bill is greatly reduced, too, not only grocery, but when we go out to eat, I have a couple bites off my wife's plate and am sated.

So, the surgery will pay for itself financially and needless to say, your health will greatly improve, so there is HUGE benefits there not to overlook.

So, if insurance isn't an option, check out the self pay route.

Good luck!

Heyher, you listed Uhc, do you mean United Healthcare? We have that and my doctor's office checked my insurance and said they cover it. Who do you work for?

Peer to peer is next week. ugh!!!!

Another week of not knowing.... My nerves are shot!

I work for a utility company. We have coverage. But the five years at 40 or higher is the sticky part Not sure if it will work. But I sent in my plea to my employer to please cover it. Because I can't just sit around letting my health decline. That is the exact opposite of what I need with my ms.

Thanks for the positive thoughts and prayers.

This whole thing with insurance just kills me. Which is going to be costlier in the long run. Me with a 40 or 25 BMI?

I love all the commercials on the radio and TV about how "(fill in the blank) wants you to thrive and be healthy" ...

I pay $400 per month with a $3,000 deductable and there is no bariatric coverage. At all. That's almost $8,000 annually. I can't even go see a nutritionist through my insurance because I had WLS.

Thanks for helping me THRIVE!!

Sorry ... rant over.

But I hear they bend over backwards and are so compassionate. :-)

Vent away sir.

This whole thing with insurance just kills me. Which is going to be costlier in the long run. Me with a 40 or 25 BMI?

I love all the commercials on the radio and TV about how "(fill in the blank) wants you to thrive and be healthy" ...

I pay 400 per month with a 3' date='000 deductable and there is no bariatric coverage. At all. That's almost 8,000 annually. I can't even go see a nutritionist through my insurance because I had WLS.

Thanks for helping me THRIVE!!

Sorry ... rant over.[/quote']

I totally agree !!! It's a bunch of bullcrap ! I am

Paying 13K out of pocket bc my insurance won't cover it but in the end I am going to be saving them money bc I am going to be a lot healthier . I pay 400+ too with a 3,000 dollar deductible and it's all a bunch of crap ... I totally get the rant

I hope everything works out for you on this route. But know that self-pay is also an option. My insurance didn't cover any form of bariatric surgery' date=' but I knew the consequences of my obesity were ravaging my health. I took a second mortgage on the home (some places offer financing) and plopped 10,400 to have it done in Vegas (baby!). Had a wonderful experience there and my restriction is still awesome.

While that is a lot of money out of pocket, I was able to itemize it on my taxes and I know my healthcare expenses over the past year have been reduced because of it. Also, my food bill is greatly reduced, too, not only grocery, but when we go out to eat, I have a couple bites off my wife's plate and am sated.

So, the surgery will pay for itself financially and needless to say, your health will greatly improve, so there is HUGE benefits there not to overlook.

So, if insurance isn't an option, check out the self pay route.

Good luck![/quote']

Just curious what I need to request from dr/hospital to itemize & use that to help. :-) I paid $12300 out of pocket. Thanks!

I am sending out positive vibes that your insurance will come through for you. *hugs*

Just curious what I need to request from dr/hospital to itemize & use that to help. :-) I paid 12300 out of pocket. Thanks!

You just need to request an itemized breakdown of the bill. You will need it when you fill out your forms come tax time.

Peer to peer Wednesday. Also the people at my work are going to talk to UHC to see if an exception can be made within the perameters of my companies plan.