In Need of Prayer.........Waiting on Appeal

[ebeeze824 1]

I started on this journey back in January 2010 and I'm still on the road keeping my prayers focused on my goal. I completed all my task and requirements by the end of March so my paperwork was submited and DENIED. I was denied because United Health Care claimed that I didn't have five years of documented weight history. So I gathered up all my medical files for the last 10 years and sent them over yesterday July 21. I just need somebody other than me to pray about this decision and keep me uplifted because my hope is going down slow. What do you think of this letter?

Dear Medical Appeals Division,

I am writing this letter to appeal the United Health Care decision to deny coverage for LAP BAND Surgery. Based on the letter of denial dated April 8, 2010, this procedure was denied because “no five year medical history." According to the Benefits Department at United Health Care there is no stipulation stating you must have five consecutive years of documented weight history but only five years which I have included with this letter.

As you may have based your denial on incorrect or incomplete information, I wanted to provide the following information that shows why I disagree with your denial and why I believe LAP BAND Surgery will significantly benefit my health and should be approved.

At this time, my doctor Pamela Thompson believes that LAP BAND Surgery is medically necessary and is the appropriate treatment for the below mentioned health conditions. I have also included with this document a letter from Dr. Jamal Farhan stating that I meet the requirements for the Lap Band Procedure.

8/20/02- IUD removal, weight 298 lbs- see attachment A

4/6/05- Diagnosed with Extreme Obesity, Fatigue, Back Pain, weight 316 lbs, medications noted Adipex and Merida- see attachment B

5/9/05-Diagnosed with Obesity, f/u for back pain and fatigue, weight 312 lbs-see attachment C

7/10/06- Diagnosed with Obesity, weight 313 lbs- see attachment D

1/19/07-Diagnosed with Morbid Obesity weight 326 lbs, fatigue and snoring, medications Adipex and Provera - see attachment E

2/21/07-sleep Study- see attachment F

10/23/09- Diagnosed with Morbid Obesity weight 350 lbs, BMI 54- see attachment G

1/22/10-Diagnosed with Morbid Obesity weight 354 lbs, BMI 55-referred to specialist for lap band procedure-see attachment H

2/24/10- Went in for initial consultation with Dr. Jamal Farhan at Hurley Medical Center

I also have a family history of stroke, diabetes, high blood pressure in both my parents and heart attack.

Based on this information, I am asking that you reconsider the denial and approve coverage for LAP BAND Surgery. My doctor has estimated a scheduled surgery date for September 1, 2010. If you need any additional information, please contact me

Do you think this letter is effective at all?

[ladybug on a mission 0]

I hope and pray that UHC will approve your appeal! Your letter is well written and contains the info they should need. I will certainly lift you up in my prayers. Please keep me posted on your journey.

[ebeeze824 1]

Thank you so much :biggrin:

[losethemess 14]

Praying for you, hoping you denial will turn into an appeal quickly.

[123crod 170]

You and your situation will be in my prayers too! God can move moutains!!

Cheri

[Cocoabean 430]

Very well written! Best of luck, a prayer just went up for you.

Any person with a brain can see that you most likely did not go on a crash diet and dip down into a "normal weight" category in the intervening times where you did not have a weigh-in during 2008! Even if you had, you certainly gained it back, which proves that conventional dieting has failed you.

Might you have any pictures of yourself during that time period? Maybe from a wedding that the date could be confirmed?

[spoiltmom 44]

It looks great to me! I'll be praying that you win your appeal. Sometimes with UHC it can as simple as getting one person that knows more than the other. I've had to appeal several simple things with them and they always granted my appeal and paid my claims. They seem to have a lot of reps there that don't really know all the rules.

[breathingez4u 0]

Is your physician's office helping to get you approved? I've been on my journey since December 2009 and just got approved last week, a week before my scheduled procedure! I handled none of the pre certification, the process was handled by the physician's office who eventually had to have the physician speak with the "higher ups" of my insurance company and that's what got it pushed through. I will continue to pray for your success.

[ebeeze824 1]

My physician is helping me out as much as she can. She approved my letter b4 i sent it off with the documents. She just told me to stay on it because my contract only ask for five years history not five consecutive years of history. Which the UHC benefits dept suggested that I wait until 2011 to give me five years history which would be 06,07, 09,10,11 so I figured if they can take that without a 08 then they can take a 05 weight and do the procedure this year. There will never be a 2008 because I didn't go to the doctor at all during that time cause I lost my coverage when the recession hit and lost my job :bolt: so hopefully my appeal goes thru and I can get going on this

[ebeeze824 1]

Hello everyone. I just want to thank everyone who prayed for me during this time. God is a miracle worker. My appeal was approved on 8/5/10! I just found out today:thumbup: I am sitting here on the edge of the earth with excitement waiting on the surgeon's office to call me and give me a date for my surgery. OMG, I just can't believe i'm finally here.

[ladybug on a mission 0]

Awesome news!!!!!!!!! Congratulations!!!

[Cocoabean 430]

That is great news! Way to go!

Best wishes for a quick date and speedy recovery!