MinkysMom

Hi, I'm new here and but have been reading the forums for awhile. I just found out that UHC PPO denied my approval for LAP-BAND®. My doctor's office and I knew that UHC had a requirement of a BMI of 40. However, I was only a BMI of 39 with co-morbidities of Type 2 diabetes and hypertension. We thought we had no problem and that UHC would take the 2 co-morbidities into consideration. But it was flat out denied. My doctor's office even asked for a peer-to-peer consultation with my surgeon and UHC's doctor to discuss but UHC said there is no wiggle room for that either. Has anyone experienced this before with my same conditions? Did you appeal and get approved? Do you suggest I work with an Obesity Law advocate to help me appeal? I really think I have a good case. I'm trying to stay positive with all this. I really don't want to raise my BMI to 40 as I feel that will really harm my health even more due to my current medical conditions. Afterall, I strongly feel with an amazing tool as the LAP-BAND® it will help cure me of my diabetes and hypertension. Any insight is great appreciated!

Thank you so much everyone for your insight and support in this. I've been bummed and trying to figure out what my next plan of action is. I was denied last Thursday and still waiting for UHC to send my denial letter which will give me instructions on how to appeal. Leona, you are an angel and thank so much in advance for sending that letter so I can help plead my case to get approved. If all doesn't go well, then I'm definitely wearing some weights at my next eval. Thinking positive!!!! I will get this done! =)

Thank you so much for that, Leona! May I ask what exactly you included in your letter to get you approved. Also, who did you exactly send it to? The care coordinator? I seem to get the run around from insurance so I want to make sure I get it to the right person. I have a strong case with my 2 co-morbids. Also, how long was the process after you sent that letter? Was it with the appeal? Sorry so many questions but I want to move on this quick. Last October, I was even hospitalized for chest pains which concerned the doctors due to my hypertension. Turned out everything was fine and I ended up paying a huge amount for an overnight stay, testing and lab work. I'm tired of all the doctor visits, medication, and blood work I continuously have to do because of my diabetes, hypertension and now high cholesterol. I'm in my early 30s and taking 5 different medications to treat my conditions. I know the lapband is the best thing I could do to help with losing the weight and finally get off all these meds.