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DENIED!

vandernoordh

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Renkoss    420

Renkoss
Posted

Hoping and praying that the peer to peer review gets you approved. UHC is a difficult insurance to approve WLS. I've read others who have had difficulties with them (some on this site).

Keep in mind that it isn't necessarily the insurance company itself that automatically denies. The policies are written for each contract (or company), so it could be where ever the insurance is through (husband's job, your job) and how the policy/contract is written that may or may not allow WLS with only a BMI over 40. I would also speak to HR at the workplace who the insurance is through.

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Brenda Sherwood    64

Brenda Sherwood
Posted

I was denied also for the same reason only they called it "no disabling condintions" even though I have a BMI of 46. I was already in my preop diet, took off from work, had family in town to help...everything. insurance conpanies are so frustrating. I hope yours goes well, still waiting to hear back on my appeal

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vandernoordh    63

vandernoordh
Posted

My peer to peer review did not overturn the denial. I have an apt with a cardiologist to address some vein issues and also have a sleep study scheduled. We'll see where that gets me

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MuffinzGamma    7

MuffinzGamma
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.

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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.
I requested a sleep study bcuz i was constantly waking up choking and gasping, thought i would suffocate in my sleep it was so bad! Snoring like a bear.....negative study I am so pissed! Not only bcuz i still think i need a cpap but also bcuz i have no comorbs, my bmi is hovering. After reading this i will have to re-read my insurance criteria to qualify. If i go thru all of this and get denied for something like this i will scream!!(and cry)

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TheDefiler54770    20

TheDefiler54770
Posted

I'm so glad I chose a local company as my h.m.o instead of a giant like UHC. The large corporations are always out to screw people. My local provider has a good relationship with the surgeons in the area and will usually approve whatever is medically necessary without any headaches.

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KristenLe    5,979

KristenLe
Posted

Just an update: I did a sleep study that showed mild sleep apnea. Not sure if UHC will approve it for mild apnea. Any thoughts?

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Sleep Apnea is sleep apnea - mild, moderate or severe so I would assume they will consider that a comorbity. I have mild as well but my "problem list" from my PCP indicates Chronic Obstructive Sleep Apnea" as my diagnosis.

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cajackson    20

cajackson
Posted

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!

Definitely call and have the doc do a peer to peer over the phone, sometimes when that happens it's just a misunderstanding or a code is not quite right.

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Renkoss    420

Renkoss
Posted

Wooohooo! It's so close too! Good for you. You will be so happy you did this!

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Marissa.Ann.C    21

Marissa.Ann.C
Posted

i am so sorry this happened to you! I would look up the policy online then call and read it to them and demand to know how you were denied when you met the qualifications. peer to peer review won't do anything if they are saying you don't meet the qualifications when you already do. i know this post is from a while ago... how did things work out?

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

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    • Aunty Mamo

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      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
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    • BeanitoDiego

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      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
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