Hi everyone!

I went to my first appointment today and found out my insurance requirements (I have United Healthcare Choice Plus) -- 40 BMI or 35-39 BMI with two comorbidities, and 5 year health history with 40 BMI. Today when I weighed I was at 40.5, and I know I was not that high through the last 5 years, although I am sure I was above 35.

The only comorbidity I have is hypertension although they told me the insurance might not count it b/c I am not on meds. I am scheduled for a sleep study which might diagnose me with sleep apnea.

Anyone think I have any chance of getting my insurance to approve? Thanks!

Hiya! I have UHC as well. My plan required I be employed with my company at least 2yrs the other requirements were pretty much the same. However, I only had 1 comorbidity-mild obstructive sleep apnea. I didn't have the 5year history-only the last 2 years. I had to write a letter (made it personal not technical) and got approved within a couple of weeks. From what I understand the insurance company wants to make sure that this isn't a sudden weight gain over the last few months and you are doing this to lose it quickly. I believe they just want to make sure it is necessary.

I had my surgery NYEve and it was inpatient. I didn't have a problem getting that authorized either as they submitted everything at once.

Good Luck on your journey..keep us posted!

Cheryl :scared2:

Hiya! I have UHC as well. My plan required I be employed with my company at least 2yrs the other requirements were pretty much the same. However, I only had 1 comorbidity-mild obstructive sleep apnea. I didn't have the 5year history-only the last 2 years. I had to write a letter (made it personal not technical) and got approved within a couple of weeks. From what I understand the insurance company wants to make sure that this isn't a sudden weight gain over the last few months and you are doing this to lose it quickly. I believe they just want to make sure it is necessary.

I had my surgery NYEve and it was inpatient. I didn't have a problem getting that authorized either as they submitted everything at once.

Good Luck on your journey..keep us posted!

Cheryl :scared2:

That's great to hear Cheryl! My paperwork was submitted to UHC today and my situation sound pretty much the same as yours. I am also using Dr. Marsden!

I love Dr Marsden! Very chill and down to earth. The day of my surgery my hubby and mom were with me. He met them in preop then after surgery went to speak with them. He gave them the surgery pics of my band placement and took a moment to actually talk to them and answer their questions. In the preop group consultation (a few wks before surgery) he was so open to answering questions & I didn't feel like he was avoiding questions. Even when we talked about the possible problems with the lapband system, he was straight forward.

I hope things go swiftly and you get your approval right away!

Cheryl

Anyone from Bham Alabama. I'm looking for a Dr. that accepts United Health Insurance and does Lap Band..

12 my surgery coordinator called said she needed one more weight visit, a letter from my PCP and Psych and Nutrition. I saw my PCP on Friday 1/16 weighed in and he said he'd work on my letter over the weekend. I completed Psych and Nutrition today so that should all be to the office sometime this week and request for approval can be submitted.......

We'll it's been over two weeks since I saw my pcp they finally got the letter to my surgeon's office but didn't send the last weight documentation :confused: they were trying to do that Monday but due to storm here in Louisville last week everything is behind. One more piece of documentation then my packet can be submitted........

I have United Healthcare. I received a letter today asking for all the medical records to substantiate what my surgeon had listed in his pre-authorizaion summary. They did not ask for 5 years or say I needed any specific BMI. All the letter asked for was medical records supporting my diagnoses, including all lab reports and physician's notes. They asked for a list of medications I am taking.

The letter said they will attempt to expidite my request but it can take up to 45 days. My surgery is scheduled for 2/18/09 so they had better hurry. I am going to take this response from my insurance company as a postive step towards my surgery.

I wish you good luck Sunbnny! I hope that UHC approves you quickly so you can start your new life soon!

About a month ago I was denied the surgery thru United HC due to my BMI dropping below 40 (39.9) in one month out of a 5 year history !! :thumbup: I have diabetes, hypertension, thyroid problems, sleep apnea and many other health problems. Each policy is different (even within the same company - United, BCBS, Cigna, etc) so you really need to read the benefits carefully. My insurance strictly goes by BMI, not other risk factors. The good news is: I filed an appeal with a letter from my regular physician explaining I was at more risk by not having the surgery. Also, there was an error in the BMI reading in a previous year. I am finally going to have my surgery!!! YEAH!!!:thumbup:

I was so happy to find this thread. I also have UHC choice plus and I was a little concerned about whether or not I would be approved.

My BMI is 35.1 and I have PCOS,

I had gestational diabetes with both my pregnancy's and

my paternal grandmother and father both had diabetes. (both died in their early 60's)

I also have documentation for the past 6 years for weight loss consults through my PCP's office (he has had me on every prescription drug out there and none of them worked) but I dont think my BMI was over 35 everytime I went.

My sugar level is very close right now to putting me in the diabetic catagory and I'm really hoping that I can get my insurance to approve the lap band.

Dose anyone know if I have enough "stuff" to get this approved?

My advice would be to have a sleep study done to see if you have sleep apnea. Also, when you submit your weights only submit the ones for each year that were over 35 BMI. Gestational diabetes does not count and neither does PCOS. UHC accepts only hypertension uncontrolled despite 2 medications, hyperlipidemia uncontrolled despite meds, heart disease, uncontrolled diabetes and sever sleep apnea. Good Luck!

Edited February 9, 200917 yr by nursekathy2u

Congratulations!

My summary plan description does not say a thing about 5 years of history. All it says is that there must be a medical necessity in order for morbid obesity to be covered. I am not morbidly obese yet, my BMI is only 38. But if they deny me don't think I won't put on that extra 10 pounds that will bring my BMI to 40! If the insurance company denies me, I will file an appeal because I have hypertension, hyperlipidemiam, non insulin dependent diabetes just to name a few. Having this surgery could save my life. I have done every diet known to man and even taken prescription diet pills. Everything goes ok until I go off the pills and then the pounds return with their cousins. Insurance companies only care about the cost associated with the proceedure. I wish they had to live in my body!

*WAVES to all my fellow UHCers*

I went to my seminar in late october and had my consultation in early november the doctor said my BMI was too low to qualify without co-morbidities and suggested I get a sleep study. Did the sleep study on 11/24/08 and got the results two weeks later saying I had severe sleep apnea. The patient coordinator gave me the hardest time about the wording on the results of the sleep study and I wasn't able to submit the paperwork that was to her liking until 1/5/09. She told me she would submit the paperwork for authorization but said it would take NO LESS THAN 30 days to get a response. I said ok and I waited and waited and waited patiently. I call UHC to check on the status late january and they tell me nothing has been submitted. I am livid!!

I call the surgeon's office and no one can tell me why my paperwork wasn't submitted. On 2/9 I get a snarky voicemail message from the patient corrdinator saying she has submitted the paperwork and they should get a response in 30 days. On 2/13 I get a call from the surgeon's office saying I was approved. I went to my pre-op visit today and one of the assistants who had always been sweet to me told me that the patient coordinator didn't want to submit my paperwork because she didn't think I would get approved. You have no idea how much this makes me angry. I should also add that I went to a cardiologist because I was having palpitations. It turns out that I have high blood pressure and a mild form of hypertrophic cardiomyopathy,

I had to do my own research and basically find out if I had co-morbidities that would help me get approved. I suggest that you get a full work up because you may have a problem that you're not even aware of. It took them only 5 days to approve my surgery and give me a date. I have a BMI of 38, Sleep Apnea and High Blood Pressure.

If your surgeon's office is reluctant to help you then do it yourself!!

Edited February 17, 200917 yr by Aurelia

Aurelia

Congrats on your approval. I'm blessed with a great coordinator at my surgeon's office and I've told her several times.

My packet was submitted on 2/6 and I too was told that it would take about 30 days. I got impatient and had to call UHC to check on the progress....WELL the representative was looking at my data and said OH! I asked if something was wrong.....UHC had me logged as a MATERNITY Preapproval......I'm a guy that looks like I'm having twins not actually having them.....ROFL.

I hope this misclassification doesn't delay my paperwork.

COngradulations on getting approved. It is amazing how a lot of people like to hold other backs and not get things approved for people who need to have medical treatment or other things like loans etc.

Chris

JayTee:

Lol! I got a kick out of this post! Congrats on your decision... Good luck!

Thanks Lucky

Like I said my coworkers got a huge kick out of it. Looks like it didn't delay anything and they are fixing that part.

UHC did call back and say that my packet was in "notification". I'm not sure what that is, sounds like perparing to let me or the Dr's office know the result. I'm on so many meds for heart, cholestrol and HBP the Dr. dosen't think I'll have a problem.