United Healthcare Denial?

rulooknatme · August 27, 2008

Hello, I just wanted to ask you if your five year history included a BMI of 40? The reason I am curious is because when I talked with Lap Band Solutions yesterday, they said that in my five year history, my BMI was a little under 40. I don't have any co-morbidities. I am afraid that I am going to be denied. =0( My BMI as of right now though is 41.1 though! I also have UHC Choice Plus, I just hope that I get approved. The UHC plan that I have through my employer is awesome. I went for a sleep study last week but I don't have the results back yet. However, even if I did have sleep apnea, that would only be one co-morbidity. I believe I need two. The girl that is working on getting the lap band approved for me said that sometimes the insurance company will take a joint disease as a comorbidity. I do have a joint disease in my knees, so who knows? OH, I WANT TO BE APPROVED SO BADLY!!

Any support will help!

Thanks!

rulooknatme · August 27, 2008

I had to get my records from my PCP and my OB/GYN. I went in on 7/3 for the diagnostic and they did bloodwork, ekg, etc. I was submitted to insurace on 7/11 and got approval on 7/21. I have a tenative date of 8/1 scheduled but I do not think we will make it as I still have not done my pre-op tests.
But good luck to you!:thumbup:

Hello, I was just wondering if in your five year history, did you have to have a BMI of 40 or more? Or did you just have to have an obese history with a current BMI of 40 or more? I'm wondering because I have a BMI of 41.1 now but it was a little under 40 for the past five years. I hope that I get approved. My UHC plan seems to be really great so maybe....just maybe...I will get approved.

Any feedback will help!

Thanks!

Boopie · August 27, 2008

Um in regards to the BMI history Im not totally sure if my BMI is stated on my records but I do know that it stated that Im obese. Tomorrow I will be going to my PCP at Kaiser and I will make sure he states what my BMI is. Which I know is over 40 with a few co morbs like acid reflux pre diabetes joint/back pain and possible sleep apnea (I need to be tested) . As you can see right now Kaiser is my provider but as soon as open enrollment is available (next month) I will totally be switching to UHC. Because I heard the Kaiser way is like forever. Ill get all the info tomorow at my dr.s appt. Hope this helped:smile2:

Melisa1 · August 27, 2008

I have UHC too. What you need to do is call them and ask them if they cover for bariatric surgery. Ask them if there are any restrictions or exclusions on your policy. They should be able to read it straitght up to you and tell you if you have coverage. Every policy is different. Looks like mine covers. Good luck!!:cursing:

tcbeau · August 27, 2008

Hello, I just wanted to ask you if your five year history included a BMI of 40? The reason I am curious is because when I talked with Lap Band Solutions yesterday, they said that in my five year history, my BMI was a little under 40. I don't have any co-morbidities. I am afraid that I am going to be denied. =0( My BMI as of right now though is 41.1 though! I also have UHC Choice Plus, I just hope that I get approved. The UHC plan that I have through my employer is awesome. I went for a sleep study last week but I don't have the results back yet. However, even if I did have sleep apnea, that would only be one co-morbidity. I believe I need two. The girl that is working on getting the lap band approved for me said that sometimes the insurance company will take a joint disease as a comorbidity. I do have a joint disease in my knees, so who knows? OH, I WANT TO BE APPROVED SO BADLY!!
Any support will help!

Thanks!

I was denied twice with a bmi under 40 with one comorbitity. My bmi went up to 41 we resubmitted and were approved in 10 days. My surgery was tuesday the 26th. My bmi was not over 40 in my 5 year history, I was always over 35 though. Hope this helps

rulooknatme · August 27, 2008

Thanks for the reply Boopie and Melisa 1 good luck to you both! Thank you tcbeau! You give me hope! My BMI has always been over 35 throughout my adulthood so I hope that helps. I am so tired of waiting. I feel sad that if I don't get approved I will have just wasted my time. I know that I can appeal and what not. I just don't know if I have the fight left in me. I am at my wits end with my weight and just want to be healthy and thin. Thanks for replying though! I'll keep you posted. Everything was submitted to insurance yesterday. Gulp!

Edited August 27, 2008 by rulooknatme
Forgot to say thanks

Boopie · August 27, 2008

KingsFan So you have United Health Care? I have Kaiser and Im waiting for open enrollment next month, with my wonderful employer, (AT&T) yellow pages formally Pac bell Yellow pages oooopps getting off subject, anyways I just found out 1 hour ago that Kaiser doesnt cover the Band so Im gonna switch to UHC, what is the procedure and how long does it take???

Chris61 · August 27, 2008

I have UHC and I used five years of dates at the doctor and was approved with no problem. If you e-mail me I will forward you an example letter that my wife and I used to get approved. Also my wife doctor would not help much with weights in the letter so we went to her OBGYN and he did the exact same letter and was approved within 15 minutes after being resubmitted. We will be a year out next month and doing well.

vcw61@excite.com

Chris

tcbeau · August 27, 2008

Thanks for the reply Boopie and Melisa 1 good luck to you both! Thank you tcbeau! You give me hope! My BMI has always been over 35 throughout my adulthood so I hope that helps. I am so tired of waiting. I feel sad that if I don't get approved I will have just wasted my time. I know that I can appeal and what not. I just don't know if I have the fight left in me. I am at my wits end with my weight and just want to be healthy and thin. Thanks for replying though! I'll keep you posted. Everything was submitted to insurance yesterday. Gulp!

You will be approved. I fought with them for five months, and all I needed to do was gain 10 lbs!!!!!!If you need anything just let me know, you can even send me a private message with any questions. It will go fast, as I am home recuping from surgery yesterday, I am excited about what the future will bring. I am so sick of being fat. Best of luck to you. Chrisy

KingsFan · August 27, 2008

My doctor's office just called to say that my claim was denied because my BMI is too low. My BMI is 35 and I have type 2 diabetes, high blood pressure and high triglycerides. I was suprised because UHC paid for all the pre-op appointnents and testing. Anyway, my doctor's office recommended I appeal because appeals often are successful. So off I go to appeal land. I'm keeping my fingers crossed.... If the appeal is unsuccessful, I will just have to self pay because my doctor says this is the best chance I have for curing my diabetes and living a long life.

rulooknatme · August 28, 2008

Thanks everyone for all of the reply's. I still have hope and I will keep you all posted! Thanks again!

Melisa1 · August 28, 2008

from what ive heard over and over with UHC they like to see a bmi of 40 or more but if you have co morbiditys...i would appeal for sure and have your doc write a letter to them. Good luck.:smile2:

AliNSanDiego · August 29, 2008

I have UHC Choice Plus.

I went to my first appointment on May 23rd and I was banded on July 9th. UHC was fairly easy to deal with. The day my paperowrk was submitted for approval I started calling them and inquiring. It took them less then a week to approve me and then surgery was scheduled for a week later.

At the surgeons office I filled out my paperwork that I have been overweight almost all my life and I had aprox 3 years of weight history (39-42 bmi) from my PCP records.

Good luck and I hope your approval comes fast!!

Hello, I just wanted to ask you if your five year history included a BMI of 40? The reason I am curious is because when I talked with Lap Band Solutions yesterday, they said that in my five year history, my BMI was a little under 40. I don't have any co-morbidities. I am afraid that I am going to be denied. =0( My BMI as of right now though is 41.1 though! I also have UHC Choice Plus, I just hope that I get approved. The UHC plan that I have through my employer is awesome. I went for a sleep study last week but I don't have the results back yet. However, even if I did have sleep apnea, that would only be one co-morbidity. I believe I need two. The girl that is working on getting the lap band approved for me said that sometimes the insurance company will take a joint disease as a comorbidity. I do have a joint disease in my knees, so who knows? OH, I WANT TO BE APPROVED SO BADLY!!
Any support will help!

Thanks!

acadiamom · September 4, 2008

Well hi everyone...this is my first post--my VERY first post on any online forum, so forgive me if I don't get this right. I want to say that this string has given me hope. I was/am scheduled for surgery on September 9th and just heard yesterday that UHC denied my surgery due to "lack of sufficient 5 year history of weight loss attempts". I was devastated yesterday, but seeing what many of you have done to appeal this successfully gives me hope. My gyn has agreed to write a letter documenting that I have been obese for over 5 years. It's kind of funny.....my BMI is over 40 and has been there or close for many more than 5 years. I have co-morbidities...the last thing I thought was that I'd get a denial. I'll keep you all posted and THANK YOU for being here!

rulooknatme · September 4, 2008

Hmmmm....It's just like everyone keeps saying; all UHC plans are different. See I am kind of in the same boat you are acadiamom. My BMI is 41.1 as of right now but in my 5 year history it was as low as 38. I have sleep apnea, asthma and problems with my knees due to my weight. I just got off the phone with LBS and they are submitting my paperwork today. GULP! I thought that they were going to submit last week but they had to wait on my sleep study results. I want to be banded so badly, I can't stand it!!! I pray to God that I don't get denied. I will keep ya'll posted.