United Health Choice Plus -- Denial

[Cindy_Wisc 3]

Prior to attending the classes at my clinic, I checked with United Health and was told that my coverage included bariatric surgery for someone like me (39 BMI) that has co-morbidities. I thought I was home-free. I have a well-documented history of obesity, high blood pressure, elevated cholesterol and sleep apnea.

I went ahead and took the classes and then my surgeon's office applied for insurance pre-approval and I was flat-out denied. They said my co-morbidities are well-controlled by medication so there was no reason for the surgery. WTH????

My surgeon has requested a peer-to-peer review but I'm wondering if there's is any chance of getting an approval now.

Has anyone else had this same experience and what was your outcome?

Thanks!

[par1959 470]

Don’t you mean WTF? My insurance company has approved me, but they are equally stupid. I just jumped into the pre diabetes range at my last checkup. My insurance would not cover seeing a nutritionist until I got full blown type 2. That is one of the reasons that made me pick bariatric surgery. Insurance companies are void of logic..

[BeagleLover 1,020]

Prior to attending the classes at my clinic, I checked with United Health and was told that my coverage included bariatric surgery for someone like me (39 BMI) that has co-morbidities. I thought I was home-free. I have a well-documented history of obesity, high blood pressure, elevated cholesterol and sleep apnea.

I went ahead and took the classes and then my surgeon's office applied for insurance pre-approval and I was flat-out denied. They said my co-morbidities are well-controlled by medication so there was no reason for the surgery. WTH????

My surgeon has requested a peer-to-peer review but I'm wondering if there's is any chance of getting an approval now.

Has anyone else had this same experience and what was your outcome?

Thanks!

I would go with your surgeon... they are experienced at this. The insurance companies do this hoping people will give up. Don't!

[Megan00 38]

OMG just praying that this doesn't happen to me

I am like you I called my insurance 1st they said I am covered

Then my surgeon's office done a pre-approval they said I am covered

I called my insurance back like 3 weeks ago to ask again (they stated its cover in my insurance)

so after all this I would be highly upset .........I am already 3 months in to this 6 month sup diet

[Cindy_Wisc 3]

I started this journey in February and I had been following the diet with the nutritionist with the idea that I would have my surgery.

At this point I'm feeling very discouraged. I can't imagine the surgeon will have enough 'pull' to get them to pay.

And now I've 'fallen off the wagon' and am eating like a crazy woman.

[dallasreno 8]

Did this ever get resolved? I'm going through the thing now.

[Cindy_Wisc 3]

Still ongoing.... I filed an appeal and that got denied. I am now working on getting things pulled together to file a "Second Level Review" but I'm pretty sure that will also be denied. I just feel like I was lied to by all parties. My insurance said I was covered because I had co-morbidities but it didn't come out until the appeal that it had to be co-morbidities "uncontrolled by pharmacotherapy". My surgeon's office has worked with this insurance company before so I'm surprised they didn't know that level of detail. But to be fair I'm sure every policy is different.

I am going to have another sleep study because the paperwork that got submitted was from a study in 2010 so I'm hoping that comes out 'bad' enough that I'll be covered.

Good luck to you!

[dallasreno 8]

I just got my approval. All they needed was a copy of my sleep apnea diagnosis. I am waiting to hear back from the Hospital to schedule the surgery.