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DENIED!

vandernoordh

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vandernoordh    63

vandernoordh
Posted (edited)

I'm so frustrated. My surgery was scheduled for May 4th and I found out today my insurance (UHC) denied the authorization stating that I did not meet the qualifications because I did not have three qualifying health conditions. My insurance only requires me to have a BMI over 40 (mine is 42) to qualify OR a BMI over 35 and under 40 with three qualifying health conditions. I am so frustrated. How do I appeal the denial?

Thanks in advance!

Edited by vandernoordh

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dede0314    356

dede0314
Posted

Can your doctor do a peer to peer review? If not I would call UHC and get information about their appeal process.

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KristenLe    5,980

KristenLe
Posted

I would call and speak to a Manager at United and find out exactly the issue. Then ask your surgeon's office to help with an appeal. There's some good info on Obesity Action Coalition website about appealing. Good luck.

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vandernoordh    63

vandernoordh
Posted

Can your doctor do a peer to peer review? If not I would call UHC and get information about their appeal process.

That's what my insurance said I should do. What is a peer to peer review?

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dede0314    356

dede0314
Posted

It basically your doctor talks to someone from the insurance company to explain why the surgery is necessary. This can get your denial overturned. I would do this first before doing an appeal.

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vandernoordh    63

vandernoordh
Posted

It basically your doctor talks to someone from the insurance company to explain why the surgery is necessary. This can get your denial overturned. I would do this first before doing an appeal.

Good thing I'm at work or I would be crying. Thanks for the help.

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dede0314    356

dede0314
Posted

I know it's upsetting. I fought with my insurance company for months and went all the way through the appeals to an external review. Don't give up, that's what they want. If you meet the qualifications, I'm sure you will get approved.

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vandernoordh    63

vandernoordh
Posted

So after talking to the insurance company, even though my BMI is 42, I still have to have a comorbidity, which I don't.

Sent from my iPhone using the BariatricPal App

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Sajijoma    1,324

Sajijoma
Posted

So after talking to the insurance company, even though my BMI is 42, I still have to have a comorbidity, which I don't.

Sent from my iPhone using the BariatricPal App

are you sure you don't? Have you been checked for sleep apnea or have light stress in continence like when you sneeze? That can be comorbidity! I bet if you go to your PCP they can find you a comorbidity if they look hard enough. I technically didn't have any, but if I had been tested for sleep apnea I am certain I would have come back with it because I would wake up choking and gasping for air and feel tired in the morning.

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Sumaire    75

Sumaire
Posted

You don't have high blood pressure, sleep apnea, or degenerative arthritis in your spine/hips/knees (dumping the weight can help to slow that down)?

Just a thought...

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KristenLe    5,980

KristenLe
Posted

I would ask for that policy where it states that requirement. That's very unusual with BMI > 40 and what do they want - for you to wait until you're diabetic! That's ridiculous. Fight it!

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Sumaire    75

Sumaire
Posted (edited)

Deleted duplicate.

Edited by Sumaire

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dede0314    356

dede0314
Posted

Is there anything online that has their qualifications listed? Does it say you need a comorbidity if your BMI is 40 or above. My sister has UHC. I know the plans are different but she was approved with no health issues just a BMI over 40. I would investigate and get all the info I could. I would also still go through with the peer to peer review.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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