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I got a letter from United Healthcare today letting me know I am denied for surgery. My insurance plan requires a comorbidity for everyone - even a BMI over 40. I have GERD, and several 'minor' issues related to my weight, but do not have any major comorbidities. I'll call my surgeon's office on Monday, since I'm sure they received the same notice today. I'm so bummed, and not sure where we go from here. I know I can appeal, but I don't think I'd win because I don't have anything major.

My BP has been increasing every year, but is not high enough for meds. My cholesterol is high, but not high enough for meds. I don't think I have sleep apnea (although never been tested). My recent glucose test had me at 5.6 - the highest level in 'normal'. Again, going up, but not high enough to require interventionI suspect I might have arthritis (long shot - but something is going on and I have auto-immune issues... never thought I'd WANT to have arthritis, but now I'm thinking I might need to go in and see my rheumatoligist that I haven't seen in several years).

Has anyone ever been through a denial for this reason? Think there's any shot of making a case that I'm on track to develop these comorbidities in coming years, so doing surgery now would be best to be preemptive before real issues arise?

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Ask the people in your household if you snore at night. That is a good indication if you have sleep apnea.

You may have the option to switch to a more weight loss surgery friendly insurance company at year's end during the enrollment period. Many require co-mordities but others may make their determination on BMI solely. My insurance plan said "clinical records support a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity)".

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Ask that your Surgeon do a peer to peer review with United. This is the insurance plans way of hoping you don't fight it and just go away. Ask them to provide you the plan details that indicate you have to have a comorbity with a BMI over 40 and what comorbities count. Appeal it as much as you can. Go to Obesity Action Coalition for some good info and resources. Good luck!

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I was denied for the same reason. I'm waiting to do a sleep study as it is my only hope for qualifying with United healthcare. My BMI is also 42 but I do not have a comorbidity (only 1) which is the requirement.

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I'm sorry to hear that. I went through it for a year. 4 doctors. Testing like you wouldn't believe. Then I found my bariatric doctors. It took a year but the financial personal really helped fought for me . And as of June 28th 2016. I finally got the call I have been waiting for. They finally approved for me to have my surgery. No date yet. But like you I have GERD. I couldn't keep food down. The smell of food made me nauseous. So understand you're frustration , pain, and the pain. No pain pills seem too help

Just keep after your insurance company. Talk to someone in office that might be able to help you. Keep the Faith. God Bless You.

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This is super scary for me. I have UHC and my surgeon sent info over for approval today. I am over 40 BMI with no comorbitities, but the plan clearly states that 40+ doesn't need a a comorbidity. I'm scared they will throw a curve ball at me right at the end and I will totally be devastated.

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The surgeons office is resubmitting my request for surgery on Thursday....hopefully it's approved this time.

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@@MadisonsMommy ... United Healthcare has so many different versions of its plans, even plans with the same names can be different in requirements from employer to employee..... Don't worry yet, your plan could face different specifics.

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Me too!!!!

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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
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    • 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.
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      1. 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.

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

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