All of my paperwork was sent into UHC on Tuesday last week. I've done all of the requirements. I have a 46 bmi, diabetes, high blood pressure, and cholesterol. I figured it would be a quick approval.

Nothing but crickets.

I'm really hoping to have surgery this year, but time is slipping away. Is this common?

I'm calling the case manager Monday to see what's up.

I got denied today for the lamest reason. They took almost 15 days to tell me that 2 months of my supervised diet weren't valid, since the technically didn't fall within their 2 year limit.

The problem is I've met my deductible so these guys are effectively going to stall me off until 2013. Then I have to pay more.

So we have to send them information from 2 other doctor visits. Then wait 15 more days, which will make a 2012 surgery impossible.

So what's the out of pocket typically for VSG? I have a Cadillac plan.

I'm so sorry to here about your denial. I think that was a lame reason, I know I has UHC with my lapband and they only went by my words, but I guess with a gastric sleeve it takes alot more research. I dont alway agree with the insurance company, when it comes to your health. I also agree about the about the out pocket expenses. I just had my revision on Nov 1st I had had to paid my 1200 deduct and an addition 5000 out of pocket max for the year. All I can say is fight it and contiune to fight it.

I got denied today for the lamest reason. They took almost 15 days to tell me that 2 months of my supervised diet weren't valid, since the technically didn't fall within their 2 year limit.

The problem is I've met my deductible so these guys are effectively going to stall me off until 2013. Then I have to pay more.

So we have to send them information from 2 other doctor visits. Then wait 15 more days, which will make a 2012 surgery impossible.

So what's the out of pocket typically for VSG? I have a Cadillac plan.

I do not see the denial as lame. The requirements are fully stated and two years gives a good amount of time to meet them. Someone/somewhere simply screwed up. Did you see a doctor at any point where those two visits can be reconsidered? If I remember correctly even a visit to the PCP could be counted. If so, resubmit. It is the first few days of November, there is still plenty of time to receive surgery before 12/31. Is your surgeon's office not involved in this, they should be able to correct this. What I would do is ask to be put on my surgeon's schedule while waiting.

I do not see the denial as lame. The requirements are fully stated and two years gives a good amount of time to meet them. Someone/somewhere simply screwed up. Did you see a doctor at any point where those two visits can be reconsidered? If I remember correctly even a visit to the PCP could be counted. If so' date=' resubmit. It is the first few days of November, there is still plenty of time to receive surgery before 12/31. Is your surgeon's office not involved in this, they should be able to correct this. What I would do is ask to be put on my surgeon's schedule while waiting.[/quote']

I've met the requirements of "completing" the supervised diet within their time frame. Their documentation states nothing about the starting of the diet within 2 years of the Bariatric appt. So yes, they are in the wrong. I would be really pissed if they denied me completely and I had to redo it.

It's a stall tactic. I zero doubt in that. They took their legally allowed 15 days to respond. I'm sure they'll take their 15 days to respond to the appeal as well. I've only been paying into their plan since April, so they want the deductible from me. With almost a whole business week off between Thanksgiving and Christmas, they can effectively stall me off until next year.

Besides my bmi is 46, I'm diabetic, with high blood pressure, and cholesterol. I've been obese for almost 30 years. They really have no medical argument against my surgery. They simply put their bottom line before my health. Like I said before, I have a Cadillac plan with Fiat service. It's pretty pathetic!

I'm so sorry to here about your denial. I think that was a lame reason' date=' I know I has UHC with my lapband and they only went by my words, but I guess with a gastric sleeve it takes alot more research. I dont alway agree with the insurance company, when it comes to your health. I also agree about the about the out pocket expenses. I just had my revision on Nov 1st I had had to paid my 1200 deduct and an addition 5000 out of pocket max for the year. All I can say is fight it and contiune to fight it.[/quote']

I'll get them don't worry!

I've met the requirements of "completing" the supervised diet within their time frame. Their documentation states nothing about the starting of the diet within 2 years of the Bariatric appt. So yes, they are in the wrong. I would be really pissed if they denied me completely and I had to redo it.

It's a stall tactic. I zero doubt in that. They took their legally allowed 15 days to respond. I'm sure they'll take their 15 days to respond to the appeal as well. I've only been paying into their plan since April, so they want the deductible from me. With almost a whole business week off between Thanksgiving and Christmas, they can effectively stall me off until next year.

Besides my bmi is 46, I'm diabetic, with high blood pressure, and cholesterol. I've been obese for almost 30 years. They really have no medical argument against my surgery. They simply put their bottom line before my health. Like I said before, I have a Cadillac plan with Fiat service. It's pretty pathetic!

It's not about medical necessity, which you obviously meet, it is about the plan requirements. I had to jump through the six months of appointments/diet and my plan is pretty much at Cadillac level as well. Everyone involved told me that missing even one visit during that time could possibly mean I'd have to start over so it really isn't personal. Of course if you choose to believe it is, there is nothing anyone can do to stop you. Good luck with everything.

It's not about medical necessity' date=' which you obviously meet, it is about the plan requirements. I had to jump through the six months of appointments/diet and my plan is pretty much at Cadillac level as well. Everyone involved told me that missing even one visit during that time could possibly mean I'd have to start over so it really isn't personal. Of course if you choose to believe it is, there is nothing anyone can do to stop you. Good luck with everything.[/quote']

I'm so sorry to hear about your denial. I didn't know it was really this difficult for some people.

You can do an expedited appeal with UHC they will approve or deny within three days of receiving completed appeal.

I have UHC through my husband's company and before I even had booked an appointment with my surgeon, his insurance-liaison people called UHC for a pre-approval. I also called UHC myself to find out if they had any prerogatives (such as 12, 6, or 3 month supervised diet programs) that I needed to do before being able to submit for final approval. They told me that all I needed was my PCPs approval letter. I asked the agent at UHC to double check that for me and she did and said that was all I needed. So why am I worried then? *(Because life has taught me that when you are told one thing, you find out there is always something else.

My patient advocate told me the insurance wants a 5 year weight history (*even though I checked with the insurance and they said just the PCP letter) which I am unable to get. We live in Nevada now, but we moved here in 2011 and when I contacted my old doctor in Connecticut, they are unwilling to get me my records at this time. They'll get to it, is what I was told. Then there is my son. 22 and he only went to a doctor when he was sick after age 16, which wasn't too many times. I do have his pediatric record and that shows when he started to go up in weight.

So the patient advocate said we could write a letter stating everything and hopefully it will be enough.

Oh, well, I've rambled enough. Did I help anyone?

Yeah unfortunately my appeal has passed the 15 days response window, my case manager sucks, and I'm getting ready to escalate to management within UHC/Optum healthcare.

The case manager refuses to answer her phone and doesn't respond to email or voicemail.

Lets hope the management cares more than my RN case manager, or it will be a formal complaint to the TX Dept of Insurance.

That's something I haven't thought about... making sure I don't pass the window of time I have to appeal-- even if the nurse case manager can't resolve my issue in time.... I think I have 30 days

They blinked and I got an approval. I called them out on their lame excuse for the initial denial and called them out on their failure to meet the 15 day deadline on their end. When I emailed this to the case manager earlier this week, I made the threat of calling the state. I got an approval first thing this morning! My date is in Feb.

Does anyone know with UHC, once you are approved, how long do you have till it expires? I heard months and I heard weeks...anyone know?

For example, lets say I'm approved for surgery by UHC in January, but during pre-surgical testing I have too high a WBC count...will I have enough time to reschedule surgery or will approval expire? I wonder.

Off topic but lovealways I remember u once talking about getting the Rny what happen w that I believe I seen you on that support group did u change your mind I'm curious cause it getting close to me getting sleeve

The insurance coordinator at Dr Kim's office told me that the clearance is good for one year. But that's my plan through UHC. My employer (a very large one) has specific rules tied to WLS.