Heyher

I didn't have the supervised diet, but I am at 5 months and still waiting for approval.

I have UCH and it has been so stressful. My requirements are Current BMI 40+ BMI of 40+ for 5+ years Over the age of 21. UHC has used the 40+ for 5+ years to deny me over and over. Finally made it through all internal appeals and went to external appeal. I hope I hear this week the final answer. My fingers have been crossed for 5 months now. I just hope the external review does see this as medically necessary...

Congrats on your progress. Though after two months I don't think you can say definitively that you no longer need this site. Also I'm sure there are people on here that could benefit from your expierences.

Vomiting blood is never good. Go to the ER. $500 is not a lot if your life is possibly at risk.

Can't wear a bra furring surgery. You'll be asleep anyways. Let em free!!! :-) Also post op I don't think you will want to wear a bra. Incision might rub from what I heard.

Next week we will submit the final appeal to UHC. This level is a board of MD that ate not affiliated with UHC. I hope apnea, chronic fatigue, MS, fibromyalgia, and arthritis will be enough to convince these docs that the surgery is needed and an approval is warranted. If this doesn't work, then I'm not sure what to do. Peer to peer did not work and external is final appeal. Can't take out a loan or finance the surgery. No refinancing home loan to get it. Fingers crossed these guys will see its more then just 5 years bmi of 40+. (BMI has been well over 30 for almost 10...)

The theme I get is UHC like to deny, but third parties have no issue approving. Hoping that is my case.

Should add 18/20 top and 18 bottoms. I

5'5" 248 Still preop waiting for approval. Hope to get to 145.

I did the internal appeal and got the denial fairly quick. The external appeal was filed on the 7th and sent forward in the 12th. They have 30 days to decide. I also wrote a personal letter stating the benefits the surgery would have. I showed that this wasn't an overnight decision and that I have started changing my life in anticipation of the surgery. Hope it works. I will know by 12/12/12.

I started in July and hope to hear if I'm approved by early December for a January surgery date.

If the BMI requirements are 40+ then that is what they base the denial off of. That's what I am fighting too. It is so hard, but that is the policy that was chosen by the employer. Now before you lose hope, submit your appeal to reverse the denial stating the medical necessity based off of whatever comorbidities you have. Have the surgeon note the diagnosis of those comorbidities. Also ask your primary care to write a letter of medical necessity based on those comorbidities. Most insurance companies look for physician diagnosis of diabetes, sleep apnea, or high blood pressure. Those are the three main ones. But there are others that can help approval.

Still waiting to hear about my external appeal. But I did find out that my employer is working on changing the requirements for approval for surgery. They are looking into what options they have and trying to stay current with the requirements for surgery. Hopefully the next person who tries for surgery with my employer will not be met with the same struggles I had. Also if external appeal is denied, may be able to get approval if plan is revised.

Did you talk to the doctor? Fingers are crossed for you.

I have same requirements. I have been at or above 35 for 7 years. I have sleep apnea. I also have MS, fibromyalgea, had reconstructive knee surgery, arthritis. I did peer to peer for the first level of appeal, and told no. Sent in written appeal for medical necessity. Told no. Sent final appeal for external review. If that is a no, last option will be to beg my employer for an exception. My fingers are crossed the peer to peer gets you approval.

Also, you can let the doc know that this letter is one of the few things left before you can be submitted. Oh! Also have the doc note in the letter the current BMI and note the diagnosis of obesity.

Anyone go through the external appeal process? Just wondering what this may be like. They say no because 5 years of BMI over 40 isn't recorded. We are trying to appeal under medical necessity because of apnea, fibro, and ms. Just wondering if the external board looks at more then just the policy....

I have ms and fibro which is a main reason I am trying to get the surgery. Spinal arthritis symptoms pain management can be helped with excess weight loss. Weight reduction is a key factor to pain management.

Typically they are looking for clearance and approval from the PCP. Example: To whom it may concern I, Dr so and so, have been treating paitent xyz for the purpose of weight loss and bariatric surgery. At this time I would recommend surgery for xyz to help with yada yada yada. I feel they are a good candidate for the procedure. More professional of course. But just an idea.

PCP is writing a letter today stating that surgery would be very beneficial to pain management with fibro and ms. Gunna get the letter today and send everything off tomorrow for external appeal.

I pray you guys have an easier time then I'm having. Submitted in late August. Denied in September. Peer to peer in September with denial. Appeal sent in October and denied late October. Sending papers for external appeal this week. If denied again, don't know what is next. Financing or loan are not an option. So, we shall see.

*ill

Have you looked at implanon? It doesn't have the estrogen that raises the risk of blood clots. Get the implant and you are set for three years. Just thought I would throw that out there.