Denied by UHC w/ BMI of 39 and 2 co-morbids

[Cocoabean 430]

cocoabean i think you are about the sweetest and most helpful person! thank you so much for all of your advice! it is so nice to have someone who knows what i am going through. well i called and they said that i was denied so i asked why and they said it was because of the bmi that was 34.8 but they didn't even look at the one from the surgeons office on the same day i weighed in it was 35 they where at 2 different offices the 34.8 was from band class and the 35 was from the surgeons office. so i went back to the clinic where i had the lowest bmi to re-weigh and it was 36.4 (when i got the news i was so sad we where camping so i ate anything that i wanted :thumbup: a lot of dutch oven cooking)

i just received the denial letter in the mail today and the thing just says that my plan excludes it. but i think they are saying it excludes it due to the 34.8 bmi that they saw. they told me that on the phone. but not in the letter. did you write them a letter? that is what i am having a hard time debating on...or do i just let the doc office do it? they are not going to re-submit it until tomorrow that is when the nurse is in so i am going to talk with her in the a.m.

Thanks, that's nice of you to say. I hope it all goes well with you. Seems very unfair. They can pick and choose which weight they use. Sounds to me the one at class was a typo. Might be the way to argue if you have to appeal.

Did you speak with them today?

[phershey 1]

Thanks, that's nice of you to say. I hope it all goes well with you. Seems very unfair. They can pick and choose which weight they use. Sounds to me the one at class was a typo. Might be the way to argue if you have to appeal.

Did you speak with them today?

i spoke with the nurse at the surgeons office on wed the place where i re-weighed faxed over the new bmi so she was going to get my appeal together and send it in. my stomach has literally been in knots i feel like i have to throw up and my finger and feet get tingly just thinking about this :thumbup: i really am hoping for the best. but i do feel like they try and find anything they possibly can to say no....it really sucks because i feel like i stepped up to the plate to get help and control my weight and health issues before they get even worse go through this long process just for them to want to say no. it's not like this has been a walk in the park. sorry to vent :tongue2: just needed to get it off of my chest. i just hope that they look at the hard facts and see where i am coming from for once.

[Cocoabean 430]

i spoke with the nurse at the surgeons office on wed the place where i re-weighed faxed over the new bmi so she was going to get my appeal together and send it in. my stomach has literally been in knots i feel like i have to throw up and my finger and feet get tingly just thinking about this i really am hoping for the best. but i do feel like they try and find anything they possibly can to say no....it really sucks because i feel like i stepped up to the plate to get help and control my weight and health issues before they get even worse go through this long process just for them to want to say no. it's not like this has been a walk in the park. sorry to vent just needed to get it off of my chest. i just hope that they look at the hard facts and see where i am coming from for once.

I feel they do try to find every way they can to turn people down. Hoping that you will go away. I had to appeal just to see my surgeon.

If you are denied, there will be instructions about the appeals process. Don't give up. It sounds as though you might have an appealable/grievable case. It will either be an appeal or a grievance. There is a difference, and I am not exactly sure what it is.

I am hoping all goes well for you. You might start researching appeals just to give you something to concentrate on in the mean time. The book Weight Loss Surgery for Dummies has some good examples and there are some others online if you do a google search.

Start gathering your records. If you have any Weight Watchers records or other diet attempts get those ready.

It's good to have your ducks in a row.

Keep us posted!!

[phershey 1]

I feel they do try to find every way they can to turn people down. Hoping that you will go away. I had to appeal just to see my surgeon.

If you are denied, there will be instructions about the appeals process. Don't give up. It sounds as though you might have an appealable/grievable case. It will either be an appeal or a grievance. There is a difference, and I am not exactly sure what it is.

I am hoping all goes well for you. You might start researching appeals just to give you something to concentrate on in the mean time. The book Weight Loss Surgery for Dummies has some good examples and there are some others online if you do a google search.

Start gathering your records. If you have any Weight Watchers records or other diet attempts get those ready.

It's good to have your ducks in a row.

Keep us posted!!

hi well i just got a letter in the mail yesterday saying that they have received my appeal/grievance (we will see what they decide it is) but it was sent in on 9/7 and they just received it on 10/4 uuggghhh!!! so frustrating...it sucks because this is something that i want so bad i have gone through the process did seminars went to see a psych doc have done so much to get to this point and it is in the hands of my insurance company i know it wasn't going to be a walk in the park but man they are truly frustrating! oh well i hope to hear good news my fingers are still crossed and i will continue to fight! do you know how long they have to make a decision once they have received it? it is at the escalations dept now.

[Cocoabean 430]

hi well i just got a letter in the mail yesterday saying that they have received my appeal/grievance (we will see what they decide it is) but it was sent in on 9/7 and they just received it on 10/4 uuggghhh!!! so frustrating...it sucks because this is something that i want so bad i have gone through the process did seminars went to see a psych doc have done so much to get to this point and it is in the hands of my insurance company i know it wasn't going to be a walk in the park but man they are truly frustrating! oh well i hope to hear good news my fingers are still crossed and i will continue to fight! do you know how long they have to make a decision once they have received it? it is at the escalations dept now.

I am sorry, I don't know. Your state might have a website that could tell you. My guess would be somewhere in the 30 business day range, but that is purely a guess.

Also, your plan's benefits guide might have the process spelled out with timelines. Check there.

I hope you hear soon!

[phershey 1]

I am sorry, I don't know. Your state might have a website that could tell you. My guess would be somewhere in the 30 business day range, but that is purely a guess.

Also, your plan's benefits guide might have the process spelled out with timelines. Check there.

I hope you hear soon!

hi cocoabean! well it has been such a journey the last time i was waiting for my 2nd appeal well they denied it so we appealed it again and with my 3rd appeal it went to an arbitrator. well i got the letter back from them on new years eve and they turned over the denial and i was finally approved! i wanted to tell you earlier but i didn't want to jinks myself so i had my surgery yesterday and am doing pretty good a little sore the worst of it is gas lol but i have been on gas-x strips and am drinking peppermint tea and the i think the peppermint tea works wonders! the 3rd time is a charm

[BWESLEY 6]

i have united health care and they have a 40bmi rule and they dont streach on it becareful resumitting it if it is denied twice thats i.t the best thing is to gain 5 pounds eat salt and drink alot of Water before appt and they will approve u i was 39 bmi and gained 4 pound to be over the threshold. good luck