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I have UHC Sig Value Advantage *** formerly Pacificare ***. I submitted 2 years of medical records to prove that I was under a medically supervised diet and my gym membership records to get approved. I have a BMI of 40 but they wanted to me to show "motivated" attempts of trying to lose weight. They denied me at first because my doctor did not submit the records with the request. As soon as they received the records I was given a consult with the dietician 10/3/11 and a consult with the surgeon 10/6/11. According to my plan I just have to pay for the drs visits $40 copay and a $300 copay for every day I am in the hospital up to $600 total out of pocket per stay. I contacted the medical group and they are not requiring a psych eval at this time. I thought that was a requirement but the lady said only if the dr deems it necessary. So I guess I will just wait and see at this point. Next week can't come fast enough!

I just got the news I am approved for a consult with the surgeon. I jumped through the hoops and finally reached my goal! From what I hear getting the consult authorization to see the surgeon is probably the hardest part of the process. This is my story. I started 2 years ago. I went through the nutrition courses then I lost my insurance when I was laid off. So now I have UHC West (formerly Pacificare Sig Value ***) through my husband's employer. In July I found out they cover the lap band. I had a BMI of 39 at the time and I have asthma, stress incontinence, fatty liver, heel spurs and low back pain. My doctor was very helpful and submitted the authorization which was denied for lack of medical necessity (I did not have a long history with my new doctor) and they sent me an authorization to see their weight doctor for a medically supervised diet (I did not make the appt because I had 2 years with another weight clinic under my belt). I then appealed and it was denied again. This time saying that my comorbidities were not "bad" enough. I had to have sleep apnea, high blood pressure or coronary problems. The only way I could get covered was if I had a BMI of 40. So I gained the weight, as if I was not uncomfortable enough and I was so mad because I had to gain the 15 lbs I worked so hard trying to lose the last year When my doctor submitted the authorization request it was then denied because I needed to show 6 months of "motivated" attempts for weight loss even though my BMI was now at 41....ummm, hello! I have been dieting since I was 11. My nickname in Jr High was Dexatrim (kids can be mean). Anyway, I turned in my medical records from a medically supervised weight clinic that I went to for 2 years (what a waste of money did not lose a pound) and my 5 years of membership to the gym. This was just on Friday. On Friday at 5pm I received a call from a dietician. I assumed I was finally approved to see the surgeon. But it wasn't until today that I found out for sure that yes, I have been approved. Now I see the dietician on 10-3-11 and the surgeon on 10-11-11. All I can say is get ALL of your documents together before trying to get your authorization approved. It will save you time and frustration. Now I am sitting here so excited, scared and happy all at the same time. I hardly know what to do with myself! So now my question is what comes next? Anybody out there care to give a newbie some advice? I would really appreciate it! <a href="http://www.TickerFactory.com/weight-loss/wJg38Pv/"> <img border="0" src="http://tickers.TickerFactory.com/ezt/t/wJg38Pv/weight.png"></a>

Hello all, I found out that if I get approved through my insurance the surgeon would be Dr. Ramin Sorkhi. Does anyone have any experience with him? Any info would be appreciated!

About 2 months ago I went to the doctor thinking that with a 39 BMI with asthma, stress incontinence and fatty liver I would be approved with no problem. After being denied and appealing the decision I was again denied. Apparently my comorbidities weren't bad enough for the insurance. So after reading the evidence of coverage I learned that you have to have a BMI of 40 or over. A BMI of 35-39 had to have specific comorbidities. I just saw my primary doctor on Friday and am now a 41.78 BMI. She is submitting the request for authorization again. I have Pacificare Signature Value ***. I am almost certain I will now receive the authorization to meet with the surgeon. Which brings me to my question. I gained 15 lbs to qualify for the surgery. But I am right on the cusp. Should I attempt to start trying to lose a little weight before meeting with the surgeon or should I wait until I get into his office and have them record my weight first? The extra 15 lbs has made me even more uncomfortable than I already was! I just am not sure if I drop a single pound that puts me under a 40 BMI that I will be approved. I guess I am not sure if once I get the authorization to see the surgeon if I am approved for the surgery? Or if I have to see the surgeon first before I get the final approval. Does this make sense? Any help would be greatly appreciated. I feel like I am flying blind right now! Thanks for the help!

About 2 months ago I went to the doctor thinking that with a 39 BMI with asthma, stress incontinence and fatty liver I would be approved with no problem. After being denied and appealing the decision I was again denied. Apparently my comorbidities weren't bad enough for the insurance. So after reading the evidence of coverage I learned that you have to have a BMI of 40 or over. A BMI of 35-39 had to have specific comorbidities. I just saw my primary doctor on Friday and am now a 41.78 BMI. She is submitting the request for authorization again. I have Pacificare Signature Value ***. I am almost certain I will now receive the authorization to meet with the surgeon. Which brings me to my question. I gained 15 lbs to qualify for the surgery. But I am right on the cusp. Should I attempt to start trying to lose a little weight before meeting with the surgeon or should I wait until I get into his office and have them record my weight first? The extra 15 lbs has made me even more uncomfortable than I already was! I just am not sure if I drop a single pound that puts me under a 40 BMI that I will be approved. I guess I am not sure if once I get the authorization to see the surgeon if I am approved for the surgery? Or if I have to see the surgeon first before I get the final approval. Does this make sense? Any help would be greatly appreciated. I feel like I am flying blind right now! Thanks for the help!

I have a question for you ladies. I was denied by my insurance for not having a 40 bmi so I gained the weight and just saw my dr. I am at almost 42. Talk about going overboard! Anyway, can I start trying to lose some weight now or do I have to wait and see if I get approved and see the surgeon first? Any help would be appreciated thanks!