DreamsOfSkinny

Looked up on medical board. Wanted someone with none-little to none history of leaks or complications. A pioneer of the sleeve surgery. Someone who was primary bariatric surgeon and ha done over 500 surgeries. Bed side manners and felt comfortable with to ask all my questions, etc. Overall reputation of office and doctor results.

Good luck

Ughh! Well I'm waiting on the news from my 2nd level appeal and honestly hoping this flu will help me in needing to lose my 10 lbs per doc. Lose my appetite. But feel horrible none the less. Hope everyone stays well during this crazy flu season!!!

Thanks!!

Well i just called and their service is very limited for me. Only really to prevent "clinically severe obesity" patients from having surgery. Diet talk, etc. No help with UhC. But thanks anyways for telling me. I'm still wondering what the PHI info is that they should be sending me.

A lot of positive thoughts, visualizing my goal to obtain it, and prayers!!!

Good luck!! Are the ins. Saying you need certain BMI for previous 2 or 5 years?

Overnighted 2nd level appeal package -- haha yes it was about 3" thick.

I'm still a part of this group----sadly! Hoping this changes soon. Just overnighted it to my insurance. 16 days in counting for a response!

How AMazing!!! Did you get approved bc they couldn't produce that document??

I would love to not have to fight but 1) I'm hardheaded and love a debate 2) I don't have the money to self pay

Ty!! After this I think I can put together an e-book for others going through appeal process.

I called the Department of labor today They said if I'm still denied after this level to contact them again and they'll get involved with my employer. Based on the insurance company denying me for language they say is in my SPD --but actually isn't-- and for my employer nor UHC being able to provide me documentation of where this language is written. I'd hate to have to go to that level but my employer is leaving me no choice! I also found last night a couple of court cases - one with Uhc self-funded plan for denying someone for obesity surgery. Her plan stated the EXACT same criteria. I included in appeal letter and stated UHC has shown in this case that they never said she needed to have a bmI of 40 for 5 years. Prayers appreciated and good thoughts!! I also found out that by ERISA standards and my SPD UhC has to give me answer within 15 calendar days.

Well I've left voicemails for the consumer affairs person I talked to at UHC and the new representative past 2 business days with no response. I'm sure my file now reads - crazy b***h keeps calling. Don't call back lol!!! But I now have finished my appeal letter. 14 pages long plus tons of references. It's an entire package I have to mail off tomorrow - certified that is. I found out that the insurance has violated both ERISA and the Protection and Affordable Care Act, so I kindly put each code and section in my letter as well My employer is now siding with the insurance company (although it is self-insured) and says that they are adding language to my SPD for clarity. Wait wait wait. According to both aforementioned acts PLUS several court proceedings, if I can prove I relied on my SPD to base my eligibility on then that should be final say AND the employer can only change language with a 60 day heads up to employees. Sneaky bastards. Here we go again. Under ERISA I should hear a reply within 15 calendar days! NOT business. I'll once again call every other day to check status. Now I need to lose my 10 lbs so when they approve me I can have this darn surgery already.

Omg!! I was wondering what happened to you. I hadn't heard from you in a long time. How are you doig?

Oakland!! I'm still trying to get my insurance to approve it. Inbox me.

Congrats on the pregnancy. Did the dr. Say anything it being so close after being sleeved?

I was so excited yesterday! I called UHC to again ask where exactly this language came from after speaking with Lindstrom law telling me that ins. Companies can have "behind the scenes" policies and guidelines they don't always share with patients. I talked to a supervisor that was SO nice! He even gave me his FULL name AND DIRECT telephone number. I just had to thank him again for helping me look into this before I submit my 2nd level appeal. He totally agreed with me that this language is nowhere and that I should be approved based on meeting the criteria in my Summary Plan Description. I truly hope he can help shed some light on this. The consumer affairs person from corporate no longer wants to return my calls. She sent me a letter saying the case is closed for her trying to find out where the language came from for a BMI of 40 for past 5 years. It simply said that this is what it is, and I'd need to show BMI of 40 for last 5 years to be approved. Still no explanation of where this language is coming from. That was no help. My advocate from work is having a conference call with my employer on Monday along with her boss to see where this language is coming from and why if the SPD has no definition of how they define "morbid obesity", how am I being denied? My SPD only states- must have a BMI of 40. It doesn't say "had" as in past tense for the past 5 years nor does it give any other details of this minimum BMI applies to. On a separate line it states - needs diagnosis from a physician of morbid obesity for 5 years. I have now asked my Dr. To specifically write the ICD-9 code for this an state this is for the past 5 years. I feel now I should be approved. I've met all 4 criteria but insurance seems to to be wanting to apply the first criteria having a minimum BMI of 40 for the second criteria - morbidly obese for 5 years. Ughhh!! My insurance should have a clearly defined definition!! I think I found a place for improvement for 2013 policy!