So far I have a 7 page appeal letter with all of my documentation from previous denials and issues and then about 50 resources (each also printed and highlighted for info referencing). I am still being denied because I don't have a BMI of 40 for the last 5 years (even though my insurance summary plan description only states I need a diagnosis of morbid obesity from a physician for last 5 years -which I have- and standard for morbid obesity is Bmi of 40 OR 35 with 1 co-morbidity). The insurance has said there is specific language in my SPD that isn't even in there (I have copy and talked to employer and advocate) saying it has to be class III morbid obesity and a minimum of BmI of 40. I'm fighting this and hope with all of this package that someone will review it and see that I was denied 3 x's based on errors on UHC's side.

I also got 3 more letters from physicians treating my pseuddotumor cerebri in support of surgery. Sending off tomorrow

Waiting on surgeon office to fax over peer to peer appeal.paperwork I was denied for low BMI with no health issues. Reweighed me BMI is 41 crossing fingers

Waiting on surgeon office to fax over peer to peer appeal.paperwork I was denied for low BMI with no health issues. Reweighed me BMI is 41 crossing fingers

Good luck!! Are the ins. Saying you need certain BMI for previous 2 or 5 years?

No not cigna

Hi Dreamofskinny, my info will be submitted next week to UHC and i will let you know how it goes!

Hi Dreamofskinny' date=' my info will be submitted next week to UHC and i will let you know how it goes![/quote']

Thanks and good luck!!! My ins. Received mine on the 9th (per my certified receipt) but they haven't logged it into the system yet. I'll call again tomorrow

UPDATE:::

I checked with ins. And they said they received it on 1/10. Logged it 1/11. And attached a faxed letter from my doctor today, 1/14. The 2nd faxed letter from dr was faxed today but more than likely not be attached until tomorrow. No word on whether they have accepted it as urgent. That 72 hr deadline is tomorrow but then again I didn't get them the final paper until today. Hoping to hear a final decision by Friday. Prayers! I'm out of state until the 30th anyway so can't have surgery until February. But if it comes to external appeal I want to send that out before I leave on the 22nd.

Lost a few of my necessary 10 lbs for surgery so that's good. Either way it goes.

APPROVED 1/17/13!!!!!!!!!

Hi Dreamofskinny' date=' my info will be submitted next week to UHC and i will let you know how it goes![/quote']

Keep me posted. Wishing you the best and sending the most positive thoughts.

Yesss! I was approved on 1/15/12 received a call surgery is schedule on 2/19 last doc visit 2/7 blood work anesthia on 2/12 payment out of pocket $1250.00 God is awesome. Congrats that peer to peer works when your are denied.

Congratulations!!! All your hard work payed off. Hang in there and let us know your progress. Again, congrats!!

Congrats

Keep me posted. Wishing you the best and sending the most positive thoughts.

Hey lady, so far when I reached out to my surgeon's office Tues they stated they are still reviewing my file internally which could take up to 10 bus. days to pass on to ins. Im going to call tomorrow afternoon to she if they have made any headway. More to come!

Have your surgeon office call they will fight for your approval. It's a different dept that we don't have access too. So a lot of times when you call they will say they never received it. The director office will have your paperwork that only the surgeon will have access too. I hope this helps..

Yesss! I was approved on 1/15/12 received a call surgery is schedule on 2/19 last doc visit 2/7 blood work anesthia on 2/12 payment out of pocket 1250.00 God is awesome. Congrats that peer to peer works when your are denied.

Congrats to you!! My oop max left is like $1500. So with everything that would be my most (plus I still have other health things that are being processed). I already have it set aside waiting

I'm hoping to hear tomorrow for pre surgery appt and surgery date. I'm going tomorrow to do all of my blood work and tests. I'm hoping for 2/1 or 2/4 date. I have to still lose some weight though per doc so now that I have my approval I'm switch from low-fat/cal diet to probably liquid diet. I have 6 weeks left before my ins. Ends and so does my job! So this has to be done asap so I can heal and get another job.