Hey guys new to this forum!!!! So I've been dealing with this process since June 2012.... I'm 26 years old, 5'5 weigh 217. I've had a hell of a time getting all the correct info from my coordinator which finally quit or got fired. So I got denied last month because I never did my 6 month diet and did not enroll into the biriatric program.... So I was like allright should be easy to complete right! So I had my pcp sign a form with complete 6 month diet info. And then tried to enroll in program. So gave them all my info and they said there nurses are 2 weeks behind but someone WILL call me. Waited for a month and called them come to find out they UN enrolled me because now I need TWO cormorbites..... I was never told any of this info since June . And they could have called and told me i was UN enrolled. I have diabetes did my 6 month diet ... Sleep study and saw the phyco. So my next step is getting a attorney to appeal for me. Has anyone been though this before?!!

What about switching insurance companies at your next open enrollment ?

Take all your testing and go someplace else. There are too many really great doctors with superb staffs for you to mess with this one!

PLEASE PLEASE PLEASE do not give up. Call and talk to your insurance company. If that does not work, look up other options (like Mexico).

Whatever you do..don't give up!

I would have to pay 20%.... But the way it's looking this surgrey is out f the question for me... I'm <3 broken

Sounds to me like if u were prepared to pay 1500 deduct & 20% & now this 600 for attorney, that should b plenty to get u to Mexico... maybe u should atleast look into that option?

Also i have UHC through the county government where i live n it sounds like the probs ur having r deff related to ur employers choices, not UHC... UHC was more than accomidating when my husband & i got our sleeves... but they r limited to whatever stipulations ur employer writes into ur health plan :-( best of luck to u, i hope u find a way!

If the comorbidities are for bmi less than 40, just gain a little more weight. I know it's the last thing any of us want to do but I've talked to others who did just that. Get your bmi over 40 and get it recorded.

Who un enrolled you' date=' the bariatric program or your insurance company? to me it sounds like you need to get on the phone with your insurance company because your coordinator seems to be wasting your time.[/quote']

The bariatric program un enrolled me....

I live in Atlanta and had United Healthcare for years. The deductible was 5000 for the surgery not including psych tests and Bariatric classes. My surgeon in TJ' date=' MX is 4500. I'd be stupid to not go to Mexico. I'm going through A Lighter Me, but there are TONS of options out there. Good luck![/quote']

When u go out of country how do u do after care???

Also, does your company have a health care advocate? I know when I've had trouble with my insurance company in the past (they weren't recognizing one of my doctors because the bills were being submitted under the medical group and not her name), I used my advocate to deal with the insurance company and get the problem resolved.

I, too, have UHC and have all of the same requirements that you do. I didn't even know about the bariatric program until a week or so ago. Our company just switched to UHC January 1. I started my supervised diet in October. I was told by the bariatric program that joining the program just gives you a nurse that you can talk to, ask questions (either the surgery itself, the health insurance requirements, post-surgery, etc.). That iti wasn't necessary to join the bariatric program in order to have the surgery approved.

When u go out of country how do u do after care???

I found a PCP 5 miles from my house. She has 3 patients with VSG and RNY. She is going to do my follow up blood work, appointments, and check my stitches two weeks out. My surgeon and coordinator answer questions within 24 hours of an email or phone call. I just have to trust that it will go smoothly and everything will work out. Feel free to PM if you want the info for my surgeon and other research that I've done. Don't give up hope. There is a solution for everyone, here or abroad

I have a self funded plan through UHC. I have been vocal with how hard this has been and it has ended up causing me shingles due to stress. I tried to get DOL involved and got no where. If you are going to appeal I WOULD use a lawyer to help draft 1st, 2nd, and if needed external review. I have been fighting since July with UHC, and still don't have an answer.

Lindstrom is well known and well respected with helping get approval. They aren't affiliated with specific surgeons and don't get kick backs for referrals.

Keep talking to UHC, get your exact plan requirements from your employer, and fight. Also you can talk to your surgeon about what their self pay costs are. If you have a good relationship with the surgeon and you trust HIS abilities, don't let the desk jockeys at their office mess this up.

Just make sure you stay on top of them and on top of insurance.

Good luck!!!

So I might have a another chance at this!! I called my pcp and let him know how I was denied for surgery do to only having 1 cormorbite and asked him to take a look at my labs to see if there was and level that I came borderline in ... Just called back and said my cholesterol was borderline and that he will write a litter staying its high and that I have a family history of this. I don't wanna get my hopes up but I have to say in alittle excited !!! so in the am I'm gonna call and try to enroll into the bariatric program again since I have 2 cormorbititys ! Please wish me luck as going to Mexico isn't going to go well with my mother!!!

Find a new doctor! Your doc office should be guiding you through this journey.... Chin up! Don't get frustrated.... Keep going...

Please wish me luck as going to Mexico isn't going to go well with my mother!!!

If insurance isnt playing nice and you decide to self-pay there are a lot of surgeons in America that offer reasonable self-pay prices. I was looking at Mexico too, but my family just couldn't get on board. I decided to self-pay here in the states for personal reasons. But there are a few in TX, Vegas, Kansas, and other states that offer self pay at more affordable pricing.

I got my fingers crossed that they stop being butt heads and just approve you already!!

If it does go to appeals send tons of documntation, medical studies, medical journals, a letter from you stating facts regarding benefits to your health, peronal reasons of why you need the surgery, ect. If you need an example, PM me and I can send you a copy of my letter I wrote for appeals.

Good luck!!!!!!

I live in Atlanta and had United Healthcare for years. The deductible was 5000 for the surgery not including psych tests and Bariatric classes. My surgeon in TJ, MX is 4500. I'd be stupid to not go to Mexico. I'm going through A Lighter Me, but there are TONS of options out there. Good luck!

When are you going for your surgery? I'm not familiar with that surgeon but am going to research him. He's in guadalajara and charges $4500?

One thing to just consider in domestic versus going out of country is the credentials of the surgeons. Healthcare in this country is just stupid expensive that I'd look very closely at the doctors and facilities who are doing low cash price surgeries here. They may be great, but it warrants lots of research.