United HealthCare Five year history~?

AvondaleGirl · November 8, 2008

Hi,

my husband's insurance is changing to UHC in Jan. and after my consult I was informed I will need five years of proof of morbid obesity. I think my BMI was betweem 34-35 for one of the years do you think this will cause me to be denied? Does the five years just need to show you have been overweight or actually morbidly obese category? I was wondering if anyone else has gone through this? Thanks

:blink:

acadiamom · November 10, 2008

Hi there,

I have UHC and am scheduled for surgery on the 19th--I'm telling you that right off 'cause that's the good news! The bad news is that it was a struggle with UHC since I did not have a BMI over 40 for 5 years.

The first thing you need to do is review your husband's insurance plan booklet (paper or online) and see just what is stated for WLS coverage. I had the standard NIH guideline coverage (BMI 40+ for 5 years or 35+ with any of the listed comorbidities (e.g. diabetes, hypertension, sleep apnea, etc.). I also had to show evidence of a medically monitored weight loss program.) I had all that and was denied on the first submission. My PCP wrote a letter (actually I wrote it and told them this was to let them see what UHC needed...they ended up using it verbatim) which was filed with my appeal. I was again rejected. At this point I got my corporate advocates group involved, since there was no reason UHC did not approve this request. It's been a fight, but they finally approved the surgery.

If you have not yet had a sleep test, you should do so--especially if you don't have any of the standard comorbidities. Keep me posted on how you're doing, and let me know if I can help. If you want a copy of a PCP letter template, I can send it to you if you provide your email address (you can PM me). Be persistent! These insurance companies reward their reviewers for high denial rates!!! There are others on this forum who sailed through with little difficulty....but I think many more have struggled, and not just with UHC. Good luck!

yzplnxg · July 5, 2009

I would like to discuss this with your off line. My email is

necholeheadley@gmail.com. I have UHC and would like some direction as to what the PCP letter should say and anything else you can provide. My ins. requires 5 years 40 bmi. I asked about the 35 with high blood pressure. The rep said submitt it and see.. I dont know. I am over 40 now.. but have ran 37-42 over last twenty years.

Thank you for your time!!

lindac80 · July 5, 2009

I think it just depends on what plan you have, i just got aproved 1 week ago and I did have 5 yeears of medical history but they only requested 1 so that is all that i send in , and i was aproved in 2 days, the only thing i had to do was 8 weeks of a programs that its called healthy roads, so i am just waiting to set a date for surgery.

yzplnxg · July 5, 2009

That is wonderful!! Congratulations. I do know my UHC requires five years but I'm hoping with high blood pressure and other things that they might look over If I dont have every year documented. Until I have thyroid surgery........ all I can do is hope! After that, good or bad I will finally know.

jem8384 · July 5, 2009

Hi there,
I have UHC and am scheduled for surgery on the 19th--I'm telling you that right off 'cause that's the good news! The bad news is that it was a struggle with UHC since I did not have a BMI over 40 for 5 years.

The first thing you need to do is review your husband's insurance plan booklet (paper or online) and see just what is stated for WLS coverage. I had the standard NIH guideline coverage (BMI 40+ for 5 years or 35+ with any of the listed comorbidities (e.g. diabetes, hypertension, sleep apnea, etc.). I also had to show evidence of a medically monitored weight loss program.) I had all that and was denied on the first submission. My PCP wrote a letter (actually I wrote it and told them this was to let them see what UHC needed...they ended up using it verbatim) which was filed with my appeal. I was again rejected. At this point I got my corporate advocates group involved, since there was no reason UHC did not approve this request. It's been a fight, but they finally approved the surgery.

If you have not yet had a sleep test, you should do so--especially if you don't have any of the standard comorbidities. Keep me posted on how you're doing, and let me know if I can help. If you want a copy of a PCP letter template, I can send it to you if you provide your email address (you can PM me). Be persistent! These insurance companies reward their reviewers for high denial rates!!! There are others on this forum who sailed through with little difficulty....but I think many more have struggled, and not just with UHC. Good luck!

HI Acadiamom, Im in the same boat have not been at 40 BMI for 5 years im with UHC and I went to Obesity Action Coalition online and looked up some advocacy groups in my area and there was you know the senate and reps of the state and you can write them for help. is this what you did? Thanks