mrspalmour

Ok so after months of research and KNOWING this was the best option for me I have done it. No turning back now. I thought I had prepaired myself for this moment when I said to myself "OMG what have I done to myself" but it seems im not. I feel so isolated. My family is great they are really leaving the house to eat so I don't watch or am exposed to it. It feels weird to even try to get down apple juice or broth but I know I need to. I juat have to know it gets better. Im doing all my walking and sipping, sipping, sipping. Maybe tomorrow I can start my protine but for now im feeling very wried. Now I did do somthing I know your not supposed to but I weighted. I have lost 5 lbs in 4 days but anyone on the amount of food I was on pre op and post op would and that is exciting to me. Also can anyone explain to me how to make one of those ticker things. Now that I have had the surgery I feel like I need one. Thanks everyone for listening to me wine.

Thanks everyone, I knew this was going to happen and be normal. I know all will get better in time.

I have been doing the same thing for the last week. My surgery is on Dec 29th so I start my liquid diet tomorrow evening. I am almost sick of food now. I think im ready to start the liquid diet now. I do feel the worry of loosing my favorite foods but I know it will be so worth it. I keep thinking about how different next Christmas will be. Looking forward to it.

Unfortunatly I work in UHC appeals and we get these alot. We have special verbiage we put into letters that states since the benefit misquote did not result in any financial burden we dont consider the misquote as grounds to covere somthing. There is alwasy that sweet little disclaimer given in the calls about this is not a guarentee of benefits they are considered based on plan provisions when the claim is reviewed. bla bla bla. We do however put an apology in there for you. I know no help at all. I hope some day there is a way that all ins companies can get their ducks in a row and be able to provide members and providers with the correct information from the get go. The insurance companies are trying to make the member responsible for understanding their benefits. I work in it and still dont understand it all lol. Sorry to hear about your story. I hope somthing works out for you.

If on the records of that day the Dr put that they were unable to weigh the patient becuase their scale does not go over 300 you should be fine. That is as much a weight history as a number.

Is this norman. Im havins surgery in Dec?

ok then it will be fully insured plan. It will be completely up to the insurance company. I hope they take all your information into consideration. Michelle

Well I really don't know if Aetna will accept that. I do know that UnitedHealthcare dosent. I don't feel its right but they don't. I would submit it and see what happens. Then if you need appeal. Contact your employer HR department and see if they would possibley do a benefit exception for your situation. The insurance company has to listen to the group as most of the time (If you work for a big or even medium company) the policy is ASO (administrative services only) and the insurance company is really playing with your employers money not theirs. I know in UHC it has to be medcaly documented weight history which means it has to be backed up by a medical professional. I hope this helps. Michelle

I would love to be your buddy and im here in the dallas area but I don't have my surgery till about December. Im still working through the aetna criteria. Maybe ill need you by then lol. Michelle

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. I have wanted this surgery for years but had no option but self pay and I was just about to go that route. I had hoped every year that uhc would change their policy for their employees. Anyway my husband got a job with a company that allows for coverage for their members. So yay me but if anyone has questions about specific policies and if and how this surgery is covered let me know I would be happy to help. I was always happy for the people I got to approve. I loved that part of my job the denials always made me sad. Michelle

I understand your pain. I work for UnitedHealthcare and they wont cover any obesity surgeries for their employees. Seems stupid to me.

Wow guys, These stories break my heart. I work for UnitedHealthcare and I process appeals for pre service services. Many of which are obesity surgeries. I have had to process denials for people I know clearly were obese in those years however most plans especially for large companies are administrative services only. This means that the insurance company does not actually pay the claim the employer does. The employer sets up their benefits with the insurance company. As far as obesity surgery goes they can choose to exclude it all together or set up criteria a member must to get the surgery covered. I have seen plans that all a member has to have is bmi over 35 to plans that have such strict criteria its almost impossible to ever get the surgery. The point is if its written in your Summary Plan Description the insurance company does not have descretion to deviat from it. Its not their money they are playing with. If the medical criteria is not submitted it does not even see a doctor for review it is just excluded. I know its horrible and sad. I have had so so many people I want to approve but just cant. Anyway the best way around this is to bug your HR department to reach out to their account manager and get the inside person to tell the insurance company they want to make a benefit exception. Look into your plan and see who they have set up to do their appeals. Some employers do their own appeals and can make plan exceptons there. Other than that sometimes there is just nothing that can be done to sway the decision. Simple answer if its in plain black and white as criteria that must be met to be eligible for coverage you must have the documentation to get coverage no matter how logical or illogical it is. I wish there was a better way. As I said I have had to deny these myself and as bad as I want it I feel horrable denying people I know are suffering as I am however these people I was deying had the option for covereage and I didnt untill my husband got a job with a company that covered it.....YAY.... I have been waiting for years. Michelle

My surgeon's office has it all maped out. I am seeing their in office pcp who discusses exercise and has put me on weight loss medication. I have my apt set up with the psych and my three nutritionist visits. My last visit to have the three month diet and exercise program wrapped up is November 18. Im hoping to have surgery scheduled by December 30. I know this is all a pain but I can tell you I work for UnitedHealthcare and review the medical plans for obesity surgeries and this criteria is not bad and we are all blessed to even have the option to have insurance coverage for this surgery. UnitedHeathcare has made obesity surgery excluded for their employees no matter how obese they are. I am so so so stoked to have the option not im happy to jump through some hoops. Michelle

Good evening, I also am having my surgery covered through Aetna. However I work for UnitedHealthcare and strangley enough my job for many years was reviewing insurance policies, medical records and determining if obesity surgery was covered so I am very familuar with what the insurance company is looking for. Now mind you I work for United and not Aetna but I also have read over the Aetna obesity policy closley and understand it. Anyway the weird thing is UnitedHealthcare does not cover obesity surgery for their employee's. Sad I know. My husband works for Bank of America and they do cover it for their employees and family....yay....I have been wanting this surgery forever. Ok not now for your question. As long as its medical notes and has a date and weight on it you should be fine with that you have. Nothing in that policy states it has to be from the same Doctor. Also the insurance coordinator at your surgeons office should be able to look at the records you have and tell you if they are suficient. I hope that helps and congradulations on your journy. I know you must be as excited as I am. Michelle