Help! United HC denied me b/c I don't have a 5 year history

[mommyhay 0]

My wife's employer dictates United's coverage for WLS. Only requirement: a 5 year history from a medical doctor. They do not require a 6 month diet or anything. I don't go to the doctor very often, so this is a bit of a problem. I have records from 2007, 2011, 2014, and 2015. My BMI has been over 40 since 2007. I also have a letter from another doc stating that they destroyed my records from 2006/2007 because they were so old. The insurance lady at my dr's office says that UHC doesn't count 2015.

I don't have much in the way of co-morbidities... a swollen ankle. That's about it. Bloodwork all normal, no high blood pressure, relatively healthy. Which is why I never go to the doctor. I have a friend who's an MD that I may be able to have write a letter for my appeal, but she is not my official doc and has never taken my weight. Anyone else have this problem with UHC and has won on appeal? Any advice would be much appreciated.

[JamieLogical 8,727]

I'm sorry. My insurance also requires a documented BMI over 40 for 5 years. My problem was not my lack of medical records, it was the fact that in 2010/2011, I lost 90 pounds "on my own" and my BMI was well below 40 for a long time as I slowly regained the weight. I didn't peak back over a 40 BMI until this past summer, so I would have had to wait almost 5 full years to be eligible for WLS again. I felt like they were punishing me for at least *trying* to lose the weight on my own. I ended up going the self-pay in Mexico route. So glad I did! Now I will have 4-5 less years of obesity taxing my body!

[mommyof5kidz 0]

Hello:

I also have UHC and I had to have 5 year history. My nurse case manager did accept my weight for 2015. I only had 2007, 2012, 2013, 2014, and 2015. I would talk to your nurse case manager and see what she says. I have even read on the boards where someone submitted photos. I do also have sleep apnea and high blood pressure. I submitted my info on Friday 3/20 and was approved on 3/24. I'm scheduled for surgery on 4/14.

[Margie122 845]

I had United years ago and I was missing one year of weights. They denied me, I appealed and lost. THEY SUCK. I now have different insurance. I swear they make it so hard just to deny on a technicality.