SKINNYBY40

PCP is going to write a letter of medical necessity. Apparently, UHC did not even look at my heart issues on the last appeal so I might have a chance for approval. The problem is simply converting to a sleeve rather than revising the band.

I was just wondering if anyone else has had an issue with United Health Care Choice Plus denial of revision from lap-band to vertical sleeve? I have had complications for two years with gastritis, dyphagia, ulcers, esophageal dilation, and pouch dilation. I also have a hiatal hernia that by new doctor thinks should have been fixed at the time of my lap-band. My BMI is now 35 with several co-morbidities (sleep apnea, post Heart Attack, coronary artery disease, osteoarthritis, ischemic heart disease, sick sinus syndrome, pacemaker, now on beta blockers, etc...). I meet all of the criteria for revision but they just don't want to pay for the revision to the sleeve. First, they stated I did not meet the weight requirements. Appealed and now they upheld their decision stating it was not a medically necessary. I have one last appeal but really don't know what to do to change their minds. I do know that it will go the someone who has never looked at my file and had nothing to do with the original denial or appeal. Any suggestions to help get this approved? Any sample letters out there that anyone knows about? Sorry this was so lengthy! Thanks for listening!

I was just wondering if anyone else has had an issue with United Health Care Choice Plus denial of revision from lap-band to vertical sleeve? I have had complications for two years with gastritis, dyphagia, ulcers, esophageal dilation, and pouch dilation. I also have a hiatal hernia that by new doctor thinks should have been fixed at the time of my lap-band. My BMI is now 35 with several co-morbidities (sleep apnea, post Heart Attack, coronary artery disease, osteoarthritis, ischemic heart disease, sick sinus syndrome, pacemaker, now on beta blockers, etc...). I meet all of the criteria for revision but they just don't want to pay for the revision to the sleeve. First, they stated I did not meet the weight requirements. Appealed and now they upheld their decision stating it was not a medically necessary. I have one last appeal but really don't know what to do to change their minds. I do know that it will go the someone who has never looked at my file and had nothing to do with the original denial or appeal. Any suggestions to help get this approved? Any sample letters out there that anyone knows about? Sorry this was so lengthy! Thanks for listening!

Omg! I wish I had found this weeks ago. I had a fill about a week and a half ago and have had such problems with feeling like things get stuck. I am going to try this!!!:laugh::tongue2:

I have no regrets so far. I wish I had done this a year ago. I turn 40 on the 27th of this month and I am looking forward to more weight loss in the months to come. I would like to be much more active in my 40's.

Just wanted to say hello to everyone. :wub: I was banded on 09/30/2008 and have lost 25 lbs so far. I lost most of it within the first 8 weeks post banding. I had another fill yesterday so hopefully the weight loss will start to kick in again. As you might have noticed by "skinnyby40" that was my goal. Unfortunately, I might have to extend that to 40 and a half or 41 since I turn forty the 27th of this month! I wish everyone the best of luck on your weightloss journey!!!

I feel your pain. I too needed a few #'s. I wore the heaviest clothes and shoes I could weigh out and even held my purse which had a lot of change:tongue2: in the bottom! It is such a long process getting approved that by the time I had my surgery I had already gained those lbs I needed. Sad but true! I am so glad I had the surgery and you will be too! I have a co-worker that actually placed weights in her bra and socks! She just had her surgery the week before Christmas and has lost 17 lbs not to mention the "weights" she took off!!:wub: Do what you gotta do and don't look back!!!! Best of luck!!!!