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?

Can't wait til I can advertise "I got approved!" Or " I have a surgery date!"

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It will happen before you know it! Mine was submitted the 7th and approved the 8th.

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Hope things go well for you from now on

Edited July 14, 201610 yr by Nymea

These insurance companies deny everything all the time. Its the appeals and the squeaky wheels that gets this stuff approved. Good for you!!! My MD cant find ANYTHING wrong with me except BMI. Finally did sleep study and that did the trick. Still have to give to insurance company. Im ready to FIGHT if i have to. Its my life im fighting for. These insurances have a prior auth dept who has nurses making the decisions

If they are having a bad they deny everything. If it gets appealed it goes to medical doctor who then makes the final decision. Im a nurse and i can say we dont know everything. And i work for an insurance company and can say there are things i denied that i shouldnt have because i didnt understand the condition. Keep fighting!!!

Edited July 14, 201610 yr by SkinnyGalinFatPersonsBody

OMG! My surgeons office called this afternoon and my surgery is scheduled for August 11! It all seems real now!

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I read she was approved on another post!

i have been there. 2 years ago when i tried the first time my bmi was 37ish and i was borderline for high cholesterol, diabetes, and everything else was negative. i also have severe GERD and PCOS but apparently that doesn't matter. i have a VERY high family history for heart disease (heart attacks and heart failure), high cholesterol, and diabetes. still denied. i appealed, still denied. surgeon appealed, still denied. i gave up. now 2 years later and 20-30 lbs heavier my insurance requires a 6 month supervised diet and my bmi is almost 44. as horrible as this sounds, it seems to me like your only options are to switch insurance companies or to gain weight.