acadiamom

lisw55--Check with your company's benefits department. The plan booklet should either be available on your company's benefits website or they can send you a copy.

Congratulations to BigDaddy!!! I'm happy to hear someone is getting approved....UHC denied my appeal. THIS time the reason was that I don't have coverage for any bariatric surgery. I'm beginning to think no one reads over there....they correclty quoted the coverage in my plan booklet ("page 58") regarding surgery, but the quote was from the section entitled "Other Covered Services and Supplies". Go figure!!! :crying: There is another peer-to-peer meeting scheduled today between my surgeon and UHC, but they've told me that UHC won't review any further appeals after this. I'm lucky in that my company has a Participant Advocate Group that intervenes when there are problems like this. They are now officially involved too, which means not only the dr is talking to UHC, but also a corporate representative. They want to ensure that UHC is honoring the contract that they are paying $$$ for. If I didn't already have hypertension, I sure would by now.....if all of this fails, my next step is an attorney....

Hi everyone--I FINALLY got the original denial letter TODAY (the original request was submitted on August 18th and the denial was dated September 2nd)! My urgent appeal went in last Wednesday (the 17th). According to their letter, a decision for urgent or expedited requests should take 72 hours. I called this afternoon, but they had no updated decision yet. I'll try again tomorrow. Please keep those good thoughts going for me.....:redface:

I'm so happy for you! Great news.....I hope it rubs off on the rest of us who are waiting to hear about appeals! Keep us all posted on your surgery date.....:thumbup:

The first submission was about a month, and although they said they sent a letter (a denial) neither my surgeon or I received it (and we STILL have not received it!). We found out just days before my surgery (which was supposed to be September 9th) when the surgeon's office called to find out the status. The surgery was cancelled and I've now filed an expedited appeal. Salome has given me some hope, though! I'll call UHC next week and see how the appeal is coming along....all they wanted was a letter from my PCP with a 5 year weight history and associated co-morbidities (which was kind of crazy based on what the surgeon sent in originally, but go figure....)

Salome is very lucky!!! It seems every UHC reviewer is different. My expedited appeal went in today....send good thoughts my way, OK? If all had gone as planned, I would have been 8 days post-band right now . I'll keep you all posted on how it goes. It would seem the letter from the PCP was the key piece of information they wanted (my UHC coordinator said no to pictures, "the guidelines are very specific"). We'll see...it's a waiting game now....

HI everyone--It's nice to have a spot like this! I'm pretty new to the forum and SHOULD have been banded on September 9th, but received an 11th hour denial from UnitedHealthCare. They are saying I was missing a letter from my PCP (not that that was ever mentioned as being necessary beyond the REAMS of paper already sent to them!) which I've now submitted....send some good thoughts my way! I relate so much to what you all have been saying and am SO ready to have the band in. Did any of you experience this and have a successful appeal?

Hi Melisa--I sent the sample to your email address....I'm too new to this site to know how to post attachments!

Hi Melisa! I'm in that same boat, except my paperwork was already submitted. You have a great opportunity to get this together now and not go through a denial! Try to contact your primary care physician and see if they will supply a letter. That is what UHC said I needed and we're using that for my appeal. Let me know if you want a sample letter....email me and I can send it to you. WHile I don't know yet if this will do the trick, my surgeon's office thought the letter was excellent and should be what was needed.

The thing was, UHC never even notified the surgeon. We were 4 business days before my surgery and the office had not heard anything. They found out about the denial when they called for a status report on the submission. The plan now is to submit the request for an expedited appeal. The surgeon's office is still waiting on some forms that UHC was supposed to have sent them for this purpose. I'll keep you posted. In the meantime, it may help to call UHC and see what the status is of your paperwork...good luck!

Well, I have another update and hope this helps others who are dealing with UHC. My surgeon had a teleconference with the UHC medical director who denied the claim. Despite faxing additional records, they would not overturn their decision. It turns out what they want specifically is a letter from my PCP with 5 years of weights and a statement of co-morbidities. I read through some of the posts here and used a sample letter as a starting point. I ended up writing the letter for my PCP to review and edit. I work in medical research with a number of physicians, so also had the benefit of having one of them read and edit my letter before it was finalized. As it turned out, my PCP decided he liked it as is, so will be faxing that in as part of my appeal process. I would suggest to those who have not submitted their package yet to plan on including such a letter in the first go-round. Maybe this will help smooth the approval process. I'll keep you all posted on the final outcome....for now, my surgery has been cancelled until this is straightened out. A real bummer.....

Well hi everyone...this is my first post--my VERY first post on any online forum, so forgive me if I don't get this right. I want to say that this string has given me hope. I was/am scheduled for surgery on September 9th and just heard yesterday that UHC denied my surgery due to "lack of sufficient 5 year history of weight loss attempts". I was devastated yesterday, but seeing what many of you have done to appeal this successfully gives me hope. My gyn has agreed to write a letter documenting that I have been obese for over 5 years. It's kind of funny.....my BMI is over 40 and has been there or close for many more than 5 years. I have co-morbidities...the last thing I thought was that I'd get a denial. I'll keep you all posted and THANK YOU for being here!