Will know tomorrow if UHC denies...

[Margie122 845]

I got a call today from the surgical scheduler at my surgeon's office. She said UHC has given us 48 hours to "show proof of documented weight loss attempts in the last 5 years". I called my PCP (who is fantastic) and he sent over a letter. Per the scheduler, it wasn't good enough, they needed the notes. He sent over the notes. I'm guessing it won't be enough to satisfy UHC.

You see I lived in NY for 3 years, but knew I was coming back, so kept my PCP here. He only has my weight documented for 2003 and early 2007. UHC didn't care that I faxed them my Weight Watchers cards from 2005 and 2006, they will only take PCP info.

It doesn't matter that he's been my PCP since 1990 and can show a weight history over 17 years (that's always been too high!)

So while it isn't totally a "NO", I'm not expecting good news tomorrow or Thursday.

If I do get denied, I've decided to put on my big girl panties and APPEAL. I'll pay an attorney to file the appeal for me. I went to Obesity Law and Advocacy Center and they seem like just the people to do it. I've worked too hard for UHC to say NO. :frusty:

If I have to, I'll self-pay. I won't be able to afford it for a while, but I'll do it.

I would really appreciate any and all POSITIVE thoughts sent my way because I really was looking forward to being a Halloween Bandster.

Thanks for listening. :ranger:

[anonemouse 1]

Good luck! Let us know what they decided tomorrow, okay?

[stacy73 2]

My co-worker who also has UHC choice (so do I) was missing one of the years but he had a previous year so maybe you will be ok. I have my fingers crossed for you.

[Chris61 0]

I have UHC and was approved. I had a silimar things but I had my doctor use my weights prior to coming to her and she put them in the letter and I was approved. You might have them put you weight watchers weight in the letter. I hope that will help you out. If you would like to see the letter that I had written e-mail me at vcw61@excite.com and I will forward it to you.

Chris

[Margie122 845]

Thanks to everyone who is thinking of me....It's been two days and I still haven't heard. I really hope I hear something tomorrow...It would be hell to have to wait the weekend.:violin:

I called UHC today and asked for an update on the status. The said the nurse was still reviewing it. :rolleyes

Anyway, I'm still sticking to the pre-op diet...it's been hard, but I'll continue to do it until I hear something.

[Margie122 845]

Stinky UHC people....

Yesterday it was with the nurse...

Today it's with "The Medical Director"....

If my surgeon's office doesn't hear anything by Monday afternoon, they'll have to cancel.

On a positive note, I heard from Walter at www.obesitylaw.org and he said if they do deny me that I've got a good case to appeal! This is what he said...

"We are retained to represent patients with certain types of denials, like yours, at no cost to you. If you are denied, your LAP-BAND doctor/program gets the process rolling by getting an application for you to fill in, sign and fax to us with some information for us to evaluate (medical records, insurance communications, etc.) It costs you nothing to work with us through this program.

There are some LAP-BAND practices who are very active with this program - others know much less or nothing about it. If I were to guess I'd say your provider may not know about it so you should definitely let them know because they are the only ones who can get you into it....if they don't have any idea what you're talking about, have them call Kelley here and she will walk them through the whole process....all LAP-BAND programs should be aggressively using this service - it doesn't cost them anything either!"

So if I'm denied...I'm definately having my surgeon's office call them!

[ivyrose325 0]

Good luck to you !

I am so proud of you, for being your best advocate

You will be banded one way or the other !

[Margie122 845]

Just got the call today...UHC denied. I knew they probably would, but it's still a blow. Looks like I have to fight them now, but I'm up for it.

[anonemouse 1]

Just got the call today...UHC denied. I knew they probably would, but it's still a blow. Looks like I have to fight them now, but I'm up for it.

That sucks. Definitely have the surgeon's office call Walter, though!

[destiny79 0]

sorry :boink:

[Margie122 845]

The nurse from UHC called me today. It was to "discuss a recent request" and to let me know I had other options like joining a gym (UHC must give some sort of discount) or help with dieting (I think they are launching a new website in 08. When I let her know that she was the first person to call me from UHC and as of today I still didn't have the full story about my denial. She asked me if "I had really given dieting a shot". Gee - I don't know...I've done Weight Watchers numerous times, Optifast, Nutrisystem, Carbohydrate Addicts Diet, Southbeach Diet, etc. and probably spent over $25,000 in my lifetime on gyms, diet crap, etc...but I guess I haven't really given it a shot. I had to tell her I found that INSULTING. To her credit, I don't think she meant to sound so condescending....it's probably some bullshit script they gave her.

I'm appealling. My surgeon's office got the application from Walter & Kelly and I'm going in to their office tomorrow to sign it.

I had my yearly physical today with my PCP. He's great...I really like him, but I know he's not 100% behind this decision and that is giving me cause to rethink it myself. I will still appeal UHC's decision.....and continue to think on this....

Thanks everyone for thinking of me.

[destiny79 0]

Why are they denied your claim I thought that UHC was the easiest insurance company to deal with.

[Margie122 845]

Tomecia,

I'm not 100% certain why UHC denied...but I believe it was for not having a 5 year history of weight issues or weight loss...The reason I can't be sure is because they REFUSED to send me their criteria in writing for the lap-band...they would only verbally give me the criteria. The nurse told me something totally different than the initial people I spoke with.

UHC (just my opinion) is certainly NOT the easiest insurance company to deal with.

I am currently trying to get additional records from when I was in NY to send to Walter & Kelly. So far I've been successful in obtaining OBGYN records from 2001 to 2003, an ER record with my weight on it from March 03, and surgery records from 2004 (ear). Those records, coupled with the info from my surgeon and my PCP records should *crossing fingers* be enough....(Oh and my Weight watchers cards from 06 and 07)

Today was the day my surgery was scheduled for....by now I should have been napping in my hospital room, cheerfully drinking Water from a plastic cup and looking forward to Jello *sigh*.... :faint:

[Chrisann 0]

Speak to your Benefits Administrator at work. I am the one at my company and go right to the Insurance Company's rep. We have Oxford, and the rep calls me back everytime if I leave a message and explains things.

Don't let your company BA tell you they can't do it, because they can with you right there.

[aubrie 6]

Margie,

Hang in there sweetie. I just got denied a few weeks ago myself. I had one HELL of a pity party and meltdown. It's one reason I have put off the lap-band for so long. I didn't think I could face the letdown if I was denied. Well, I was. I did get depressed and gained all my pre-surgery weight back, but with the help of the folks on this message board, I appealed. so we are going for round two. My surgeon sent in 28 pages of documentation and ALL my doctors wrote letters to Aetna. If I'm denied again, I'll call Walter. I want my life back damn it!! I deserve to live like a normal person. So, I'm squaring my shoulders, gritting my teeth and holding my head up. You GO GIRL!!!!!