Hi Everyone! I'm from NW Indiana, and I started my journey nearly 18 months ago! After pills, diets, exercise, etc. I finally got a referral from my family doctor to see a bariatric surgeon last July. I called my insurance company and they said my insurance was covered if I met their prerequisites. I let the surgeon know and they of course called after my first appointment and they got the list of prerequisites. Although I had spent 6 months on a supervised diet with weigh ins twice a month, I had to do 6 months with the doctor and nutritionist, maintain my weight, have a 5 year history, show previous attempts to lose weight, etc. So I did all the standard things, and it was time to submit to insurance in February of 2020. I got a call from the nurse at UHC to check on me after my procedure, but I had not yet had any procedure. Nothing was approved yet! So the nurse checked and the procedure was denied - it was excluded by my policy! I was upset and appealed. My surgeon appealed, because they had a preapproval number from September. Still, UHC refused to cover anything. I was upset, and researched it. I found a website for my state that had information about Healthcare complaints, so I filed a complaint and included information about their calls with me and the doctor's office. I suggested that they review the calls and retrain their employees to properly look at a caller's insurance, because they always say to "Call the number on the back of your card to verify benefits." Then COVID 19 closes everything. The doctor's office closed my case, and I started researching self-pay. I found Blossom Bariatrics in Las Vegas, and I paid my deposit and scheduled surgery for June. Yesterday I received a letter from UHC. They are paying for my surgery with my original surgeon. I thought it was an error, a joke, a dream?!?! I called my surgeon's office and sent them a copy of the letter. They called me in shock and asked what I am doing in July. Well, I think I'm having my Gastric Bypass and hernia repair in July now - close to home and without traveling. I'm worried something will happen to change that. I am out $550 because I paid a deposit to Blossom and for an appointment. I called today to reschedule for now - I don't want to cancel and have my other surgery fall through and be left with nothing. My surgeon's office said I am only the second person to successfully battle UHC over their error and actually win. I am worried the bill will exceed the $40,000 limit that was not a condition of the original guidelines, and I am scared they will find a reason to refuse payment. I am anxiously awaiting surgery in 6 weeks and 4 days.

Wow! You went through a lot and I want to say congratulations on fighting for your health! You didn't give up no matter what. I really, REALLY hope the surgery scheduled in July does not fall through. I think you have made a great plan by keeping the other surgeon an option just in case. I wish you the best with your surgery.

Sometimes we have to jump through hoops to get the things that we want, but I'm glad that it seems to be working out for you! I know how difficult it is when insurance denies something you NEED! My own experience happened three years ago when I had to battle my own insurance to get an MRI so that I could get the visual proof that I have TN so that I could see a neurosurgeon and originally they denied it, but my neurologist at the time fought it for me and sent in four different requests before finally telling them he was checking for a tumor (TN can sometimes be caused by tumors, mine isn't). I was lucky that he was so set on getting approval because I couldn't even get a hold of anyone, but they finally did approve it and I got my proof, had my brain surgery and have been relatively pain free since (a few flairs came back last year, but are soooo much better than they were).

I hope everything continues to work out for you and congratulations on your upcoming surgery!

On 5/29/2020 at 4:18 AM, NovaLuna said:

had my brain surgery and have been relatively pain free since

wow! that's incredible. I'm so glad your doctor advocated for you and that you chronic pain has decreased