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ibc32oz

Gastric Sleeve Patients
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Everything posted by ibc32oz

  1. Re: United Healthcare????

    Hey there guys I work in the appeals department of UnitedHealthcare but previous to this I worked in Care Coordination and my job was to review obesity surgeries and the policies of the people requesting surgery. Alot of plans have the exclusion including UnitedHealthcare for their own employees.

     

     

    Per your posting, I am in an appeal with UHC. It's a longer story, and am not sure if you're still on here. Please advise. Thanks.

  2. My denial was drafted only on the fact that our company does not pay, unless you are over a 40bmi period. There was no notification that it was investigational. Sorry.

  3. ibc32oz

    UHC - Now Approves VSG!!!!!

    My understanding is that the 5 year history is very important if the insurance company requires it. I also don't go to the dr. very often. I had to talk with my wife concerning visits over the last 5 years. My current bariatric surgeon had seen me in December, and again in January. That right there sufficed for 2 years. I the went back to a ER visit, and a couple of dr's that I'd visited for little things like a back ache, or sport injury. I called several of them, and asked if they had information. Several of them had my stats of the appointment, and sent into the bariatric surgeon. I even called a Care Now (not sure if you have them where you are) and they had a couple of years info. I'd gone to the Care Now when having a small work injury, and for poison ivy or strep throat, and sure enough they had taken my height and weight. It may seem challenging now, but discuss with a spouse or parent....spend some time recalling where you've been over the past 5 years, and you'll get it. Well worth the time to find it, right? Good luck.
  4. ibc32oz

    UHC - Now Approves VSG!!!!!

    Well, I finally got a hold of the actual policy that my company has with UHC. It is true that you can only be approved of the sleeve (or any of the wls) if you are over 40bmi for the last 5 years. I wonder if anyone has successfully appealed while having less than 40 ( mine is 38). I guess the co-morbidity of severe sleep apnea no longer matters. Anyone?
  5. ibc32oz

    UHC - Now Approves VSG!!!!!

    Hey, Thinoneday, that's great news that you were able to get it done. What did it end up costing you for the sleeve? I've been reading all over the net lately, and wondering if it's a consideration to have it done in Mexico. We'll see what happens. I'm hoping to hear, though, that someone has successfully argued against the bmi of 40 rule.
  6. ibc32oz

    UHC - Now Approves VSG!!!!!

    I have a question for someone more knowledgable than I. I have been working on getting approved for the vsg for 6 months. UHC is the company, and I've talked to them 5 or 6 times over the phone. Went to the Dr., had the psych eval, sleep studies. Have a 38 bmi and diagnosed sleep apnea. Well, when all of the paperwork was submitted, they denied. The reason is that you need to be above 40bmi, and no other requirements. Apparently they don't approve on the 35-39.9 with a co-morbidity diagnosis. Haven't done an appeal. When an account supervisor returned my call, she advised that their tool that they use was wrong, and that's why for 6 months their customer service people were giving bad advice. I have requested a policy back in order to read for myself, but if it's true, is there any chance for an appeal? Bummed out about this, as in addition to the severe sleep apnea, have Plantar Fasciitis on both feet. Been getting treatments for 2 years, and last hope is surgery. Podiatrist says that it's from weight, so vsg could have solved weight, apnea, feet, etc. Please advise if you have any suggestions or experience like this. Thanks.

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