It's a long story but a year ago I fell and tore a tendon and bruised an ankle bone. It still hurts, I can't walk more than a few blocks without being in severe pain.

I started researching in February and had the surgeon call UHC. They said I just needed a 5 year history over 40 BMI.

I called twice and was told the same thing.

In the meantime I've gone to seminars, support groups, spent hours and hours online researching. I have never spent so much time on deciding anything.

Finally I decided for sure, went to all the tests. Had to make up all the time off work.

They finally submit and I get a denial because they want me to do a six month diet.

I'm 41, I have done every diet known to man, hypnotherapy, supplements, psychotherapy, and exercise.

I've been told if I don't lose my ankle won't heal. But I can't work out because of the pain.

I'm on an antidepressant that causes weight fIn and makes weught loss almost impossible. I have tried numerous times to get off of it. I even have taken other medication and nothing works.

I am trying to get my WW history but they are playing games with me. I was thinning maybe after surgery I might go back but not now. Because I'm not a current member they won't just print off a receipt. After I went through this a week ago and was emailed my receipts for the online tools only.

Today they say they have to fill out a form to have a department email me my reveille which takes 7 business days.

I feel fat and ugly. I hate my clothes. I have moments when I think I don't want to go on if I can't have the surgery.

I'm thinking I may just end up having it in Mexico.

Trying to keep my head up but I feel so down.

If you are set up through myuhc.com then I think the coverage documents should be on there.

I can't find them!

All I can find is that notification is required for treatment of morbid obesity to determine if it is medically necessary. I can't find anything that specifies a six month diet or a five year history.

Any idea where that might be on the site? Thanks in advance

I just found the requirements for you.

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

It's at the top of page 4. Hope this helps.

Thanks. I don't understand how some people with my insurance aren't required to do the six months but some people are. From what I've been told every employer plan is different.

it does say they will take WW in the last two years so that is good.

Now I wait for that.

I think I'm going to write a letter to them too.

My insurance covers the sleeve bit I knew if I was denied I'd fall into a horrible depression too. I went to Mexico and it was cheaper than paying with insurance anyway. I'm glad I did it that way to avoid the heartbreak.

Yes it's true every employer/insurance is different and each one can make specific changes or requirements to their policy if they choose to cover WLS. I went through Cigna. I had to do a 6 month medically supervises diet and check in with my dr each month. While in the process- Cigna changed from 6 months to 3 months supervised diet. Be an advocate for yourself- you deserve this surgery! You have paid their premiums and qualify. You have every right to these benefits. I would start the insurance process and have this time to mentally prepare for surgery. Trust me- you can never do enough research and preparing. I used my 5 months preparing by doing WW. I lost about 50 lbs- because I knew it was the last time I would ever weigh that much again. I had a good head start on weight loss before surgery and I am so grateful for that. Now at 4 and 1/2 months out I'm down a total of 118 lbs. Keep positive! I wish you all the best!!!

It's just so hard after waiting a whole year! I literally don't think I can do more research. To say I have been obssessed is an understatement.

I just find the six month requirement insulting.

I have been told by a number of doctors that if I don't get off of Paxil Im not going to lose, and i can't get off of it. In addition not being able to work and being in pain all the time doesn't help.

I had to do the 6 month. I lost 50 pounds and it was important to get my liver smaller in size.

You can do this. We are and will be with you.

Next month will be my 7th month of the so called 6 month diet - the first month doesn't count because you are just beginning. I have been frustrated the whole 6 months, I too believe that insurance could have looked at my weight from the previous years to see that I have lost and gained weight. The time has not flown by for me I have lost 21lbs. but I am constantly thinking about what I eat. I have been reading this forum and another one every day waiting my turn. If I get denied I will not be able to have the surgery, going to Mexico is not an option- no money, 3 children (1 has special needs) to take care of. My plan B is that I will have to drink protein drinks and exercise until I lose all of my weight. Choose whichever option you are most comfortable with?

I was in a similar situation. Without insurance there would have been no way for me either. I even went to the extremes of finding an employer that would have bariatric coverage. I took a phlebotomy class and got a job at the hospital where I wanted my surgery done. Trust me- I've wanted WLS for 5+ years. I've needed this- I HAD TO FIND A WAY!!! where there is a will there is always a way!!!

When you log into myuhc look for the benefits and coverage tab. There should be a link on that page to your plans coverage document.

All it says is they have to determine if its medically necessary. Doesn't say how they determine that.

Have your Surgeon or pcp write a letter of medically necessity. Citing your BMI and all your medical problems each one explaining the weight related problems it is causing. The diets you ve tried. Look on Obesity help . com for a sample letter. Basically proving why you medically need the surgery.

Good luck!