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Becky Lou, I haven't heard anything yet. My insurance required five years 40 BMI (like yours) or higher OR doctor statement saying surgery is a medical necessity. I thought the doctors letter was sent in on the original request because I thought everyone understood what the ins required and what my BMI's were. We did discuss this. But... The letter was not sent in UNTIL the insurance denied the surgery and then the ins clerk sent it in as an appeal so she waisted one of my appeals. I feel like the doctors office let me down on this one. The ins company said it would take between 15 to 30 days for a ruling on the appeal. This is day three. I am hoping so much that it doesn't take even 15 days. This is torture!!! Please keep me informed as well. Sounds like you and I are in the same boat... I have High Blood Pressure on meds runs about 158/84. GERD. Really bad joint pain that I will have to do something about if I don't loose weight. I have sleep disturbances. weak bladder. Really bad Asthma. Shortness of breath. depression. I also wrote my own letter to the insurance company outlining why I thought the surgery was medically necessary and letting them know of the diabetics that run in my family and how my dad died at age 59 of congestive heart failure and the illnesses and surgeries that my Mom is having. I explained how spending the money on this surgery would save money on joint replacements. I don't know if this will help or not but I wanted them to see that I am a real person not just a file and that this will improve my quality of life.

I was denied today.. :sad: BAD NEWS!!!! My UHC does cover the surgery with BMI OVER 40 with five year weight history. I had 4 BMI over 40 and one year at 35.5 (when I took diet pills.) I do have high blood pressure and Acid reflux but I was still denied. The doctor is going to write a letter stating this is medically needed and Lori is going to fax it to them tomorrow. I am wondering if this will be enough...

What I can tell you is that every employers policy with UHC is different. Mine requires the 5 year over 40 bmi or 35 with comorbities such as high blood pressure among others. My doctors office just sent in all mine info. All BMIj's were over 40 except ONE year and that year was 35.5 BMI. Since I had the high blood pressure and Gerd, Asthma I thought I would be approved with no problem. But I received word today that I was denied. My doctor is going to send a letter of medical necessity tomorrow and hopefully that will work. I am going to start researching and working on an official appeal tonight. I feel like UHC have approved others just like me and yet they still are doing everything possible to delay or deny the claim. I feel like I qualify based on the criterea and I feel like I need this surgery for health reasons. I'm not going to give up.

Can the next few weeks go any slower? Am I the only one here watching every second go by.. so slowwwwly..... Last Thursday I finally got everything to Dr Dewitts office. Lori is is supposed to send my paper work in NEXT WEEK!! Yea!!!! Anyone else waiting on pins and needles with me? :cursing:

Well the doctors office hear from UHC today and I was denied for not having five years over 40 BMI. One year I was 188 which meant I was 35.5 BMI. (This was when I was taking diet pills. I have comorbities which should make me elgible with 35. I called UHC and they told me to have the doctor to send a fax letter of medical necessity with explanations. All my comorbities were listed in the initial info sent to UHC so this is just a ploy on their part to slow the process and discourage me. This won't work. The doctors office will send the letter tomorrow they say. In the mean time, I will start researching to see what my options are and if there are peole that can help me. This is just yet another hurdle I have to jump through. I will not stop until all my appeals are exhausted and it this letter doesn't work the next appeal will be well thought out and documented.

Kamekar25, I know just how you feel... the last week I've been on vacation.. The beach helped so much take some of the edge off the wait. I still thought of it everyday but it was much better. Now that I'm back home.. I'm hoping I will hear somehting next week. I plan to call UHC first thing Monday. I hope I hear something next week but I'm thinking it will be two more weeks. I guess they will take the whole thirty days..

Still waiting.. Ive been on vacation.. sorry for the delay in answering. I'm still waiting. It will be two weeks this Tuesday. I've called several times and UHC says everything is pending.. One of the reps said they had ten days but the last one I spoke with said they have thirty days.. who knows.. I guess they are going to take all thirty days...

Will do first thing monday!! Thanks..

Well, I don't know what to think now.. You know, Lori at Dr. Dewitts office said she sent everything in to UHC on Tuesday so on Wednesday I contacted UHC and I asked if they have recieved a predetermination. The UHC rep said from Dr. Dewitt and I said "yes, that's it." The UHC rep said, "You should hear something from 3 to 5 days." I was soooo happy to know I was in the waiting stage and within a week of knowing something... So anyway this morning I'm thinking today is now day four.. (at least that the way I count the days.. ) This afternoon, my daugther says, "You should call UHC because it's between the three of five days. They may have already made the determination and you will know something." Within a few minutes, I'm on the phone with UHC... it's about 2:30pm. I spoke with the benefit office and they said they have NO pending or approved predetermination for me. I checked with another rep about an hour later and she told me the same thing... They said, We have nothing for WLS or nothing else for you. No doctor has sent in anything." I am wondering if UHC sent the stuff back to Dr. Dewitt for more information or what is going on?? The rep I spoke with on Wednesday was seeing something because she mentioned the type of surgery and the doctors name. Now I am so disappointed and totally confused. Anyway the rep this afternoon from UHC told me that AFTER they get the papperwork from the doctor, it could be up to thirty days before a determination is made. I understand rules and waiting periods... It's just that it's so hard when you're on the other side waiting for someone else. Monday I will call Lori at Dr. Dewitt's office to see if she will please check to see if UHC has the request. I would lat least ike to know if at least the thirty days are ticking down or are we still trying to get the paperwork to them.. Just a little more than frustrating. I wonder if UHC sent if back because they needed something... would it just show 'Nothing.' No notes at all. Lori should know this if they did.. I guess I'll know more Monday. My thryroid surgery is scheduled for two weeks from Monday. I am so hoping to have the WLS by the end of August or at least by the 15th of September.. Still on the fence..

Oh yes.. thanks so much for the info.. It would be so bad to have trouble with the ins. paying especially just because you didn't stay over night. When I have anything outpatient and they wake me up.. I'm so sleepy.. and they say... Honey wake up you need to go home.. I'd rather just stay and get the rest anyway. I think thats a good idea in case anything goes wrong.. you dont have to wonder.. should I call. I'm the type of person that hates to bother anyone. Thanks for sharing. Oh and I was at Pennys last night and I looked through the PJ's. I'm going to get me some new jammies as soon as I hear something... Hope to be shopping soon. Maybe Purple PJs.. That color so out of character for me... which is very fitting. I hope we'll be in the same boat by next week!! Wouldn't that be so GREAT!! On another note, I have had company for the past coulple of weeks. Both my daughters have come (at different times) with my four Grand daughters which I love dearly.. Then my almost (thirteen year old) son's cousin came for a week and I have had neighborhood children (boys) over every night playing guitars and spending the night.. Not all these people have been here at the same time but they have all been spending the night.. My daughters live about 100 miles away. I love for them to be here and I know all this company is all because school is starting next week.. and everyone is wanting the last hooray... but I am so exhausted. And the Snacks and groceries I have bought.. Anyway I LOVE company and love being around my family but .. I"m so exhausted. I'm taking off on vacation after 2pm tomorrow for 10 days. My husband, son and I are going to florida for a week. I'm sleeping.. and waiting to hear from UHC.. I know everything is going better for you now that you KNOW you are having surgery. The world has to look rosier!! You will feel better so soon (after surgery) and you need to take all the time they allow. I know from experience no matter how good the company is.. they know how long you should be off with a surgery and won't let you take one more day than you need. In other words, take all the time off you can because any business will expect when you come back.. you will be well and ready to work. At least that is my experience. Take all the time off. This surgery is not like most. The work begins when the surgery ends.. we have to make sure we adjust well to the rules or this won't work. Any extra time will help there as well, right? Got to go.. didn't mean to be so long winded!! Nechole..

Thanks.. YOU know what's it's like.. It's nice to have someone that understands how important this is to me...

Jem8384, After your GREAT news.. I called UHC to check on the status of my approval.. They told me the doctor had only sent it in yesterday but that I would hear something from three to five days!! I am so glad it won't be 30 days!! Maybe I'll know something by the middle of next week!! Another small step...

That is so wonderful!! What a relief knowing you're are finally on your way!! Such a big step...

I am reading posts at several websites and trying to decide which surgery is right for me. My choices because of ins coverage is the RNY and lapband. I beleive I understand the differences. When I visited my surgeon and he asked me many questions we decided on the RNY but the more I read the more I have to think about. I really apprecitate everyone taking the time to give their views on the different surgeries. The doctors know a whole lot but there is information to gain from someone who has been there first hand. Thanks to all of you for sharing your views. :smile:

I am reading posts at several websites and trying to decide which surgery is right for me. My choices because of ins coverage is the RNY and lapband. I beleive I understand the differences. When I visited my surgeon and he asked me many questions we decided on the RNY but the more I read the more I have to think about. I really apprecitate everyone taking the time to give their views on the different surgeries. The doctors know a whole lot but there is information to gain from someone who has been there first hand. Thanks to all of you for sharing your views. :cursing:

Im planning on calling Lori sometime next week when she gets back into the office and see if she has sent in my approval to UHC. Let me know if get your approval. What ins company are you dealing with?

Long2BThin... WoW!!

:lol:Are the hiring.. lol I'm hoping to be right behing you.. Just think abou the new year we have ahead of us in 2010!! It's going to be wonderful.

There is some good information here. I appreciate everyones post... especially the details. Food for thought. I'm looking into what type surgery to have as well.

Headhunter, "Bypass and the Sleeve are meant for DIFFERENT types of people and different eating disorders" Please elaborate... Nechole

Congratulations!!! I want to follow in your footsteps!

Can the next few weeks go any slower? Am I the only one here watching every second go by.. so slowwwwly..... Last Thursday I finally got everything to Dr Dewitts office. Lori is is supposed to send my paper work in NEXT WEEK!! Yea!!!! Anyone else waiting on pins and needles with me? :smile:

I went to the ENT today.. He says my acid reflux is causing my constant cough. And I thought it was my asthma... I asked them if the weight could be causing this.. and the answer was "oh, yes." Yet another reason I'm going to feel better when this surgery is behind me. Right now I don't feel so good.. and the time is standing still especially at work... We going to Florida for the first week in August. I'm looking forward the the rest. I hope to walk on the beach in the morning and the afternoon. I'm going to read some of your blogs.. I hope someone got good news today!! :thumbup:

I went to the ENT today.. He says my acid reflux is causing my constant cough. And I thought it was my asthma... I asked them if the weight could be causing this.. and the answer was "oh, yes." Yet another reason I'm going to feel better when this surgery is behind me. Right now I don't feel so good.. and the time is standing still especially at work... We going to Florida for the first week in August. I'm looking forward the the rest. I hope to walk on the beach in the morning and the afternoon. I'm going to read some of your blogs.. I hope someone got good news today!! :smile:

Sort of good news today!! I got all the weight history to Lori in Dr. Dewitt's office. I'm so glad to have that complete. All the weights were over 35 bmi with my comorbities... she says it looks good. I didn't have 2004 but I had 2003 2002 and 1998... She can't file the UHC until next week because she is doing clinicals so it will be the week after next. The waiting will be terrible but at least I'm one step closer, right!! :smile2: