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 April 28, 201610 yr by vandernoordh

See if they can email the requirements to you or if they have it somewhere online. For example I have Aetna, I called and asked for their requirements they told me to go to their site and search 0157 they have a bulletin online that states all the requirements. Maybe UHC has something similar.

@@vandernoordh If it's an insurance through your employer (or husband's) - I would see if they have a benefit coordinator that could help you. Absolutely everything I've read states 40> without comorbidities. They need to show you the exact policy relative to your particular plan. United is very good at doing whatever they can to avoid paying - and I'm sure most people just give up. Don't give up!

Thank you! I just thought this would be so much easier than it is proving to be.

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Yes, I do have light stress in continence. I have no idea that was a co-morbidity.

i just received and email from the insurance coordinator at my surgeons office and there is a peer to peer review scheduled for May 3rd. Prayers, good thoughts are greatly appreciated!

Peer to Peer review is scheduled for May 3rd!

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!

I went through UHC and they approved me next day. See if your PCP can amend your recommendation letter. I did not have a co-morbidity listed, however my PCP added that I was borderline high blood pressure, high cholesterol, and pre-diabetic. It was enough for the insurance company to approve my surgery. Best of luck!

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Good Luck... Keep us 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!

I went through UHC and they approved me next day. See if your PCP can amend your recommendation letter. I did not have a co-morbidity listed, however my PCP added that I was borderline high blood pressure, high cholesterol, and pre-diabetic. It was enough for the insurance company to approve my surgery. Best of luck!

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My letter said all of those things so I have no idea why it was not considered to be necessary

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Lindstrom Obesity Advocates.Fight this...don't give up!

Do you have sleep apnea,high blood pressure,or any comorbidies???Something was submitted incorrectly.What insurance do you have?

I have a fatty liver, high cholesterol, pre diabetic, have chronic lower back pain associated with degenerative disc disease. I think they bought the need to inform the insurance of the comorbid conditions wasn't important since my BMI was over 40. I'm hoping the peer to peer will get the job done. And I have UHC

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Edited May 1, 201610 yr by vandernoordh

@@vandernoordh,

I am sorry about this. You have every right to be beyond upset!

It sounds like you clearly meet the requirements that your health insurance policy has. Your doctor should be able to get involved on your behalf. It’s also in your doctor’s interest, since your doctor wants to keep you as a patient.

Good luck, and try to stay positive, and don’t give up!

Thank you! I'm hoping the peer to peer review on Tuesday solves the issue. I'll keep you updated!

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Have a conversation with your doctor before.They must stress your comorbidies...

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.