Denied! United Heathcare

[ebusa 1]

Hi Everyone,

I'm new to the forums and was looking for some advice. My doctors office sent in a letter of necessity recently and I have just recieved a denial letter from UHC.

I'm now in the process of research and trying to determine how to appeal. Does anyone have any example letters to share?

The letter specifically mentions they needed a 5 yr history of obesity, so I am in the process of contacting past doctors and trying to put an appeal package together.

My BMI is 38-39, have several co-morbities (high blood pressure, high cholesterol and sleep apnea). I've done all the steps neccessary (tests, studies, 6 month diet program with nutritionist) and this is such a dissapointment.

Any help would be extremely appreciated!

Thanks

Evan

Edited October 29, 2010 by ebusa
spelling

[BWESLEY 6]

i have the same insurace as u my bmi was 40 with no health problems have u had a weight problem for more than 5 years ? also if u are with a large company then have there adim call the insurance united payed all but 300.00 and pay for all of my after care. good luck contact me if you need any information

[Paigey 7]

Find out the reason they are not approving. It might be something simple like some test results were left out or co-morbidity documentation wasn't presented. You can also have your surgeons office call the insurance and go to bat for you. I think a lot of people here have had to appeal to get lap band surgery approved.

[ebusa 1]

Yes, I have a history over 5 years of weight control problems and co-morbitities. Called my surgeons office and they said the patient is responsible for appealing to insurance.

So now, I guess my next step is to contact my the PCP I had a few years ago to get my records since I changed doctors.

I would sure like to know what information was given from my surgeons office to the insurance company in the letter of necessity.

Anyone have an example appearl letter they submitted after a denial?

[BWESLEY 6]

United will assign a nurse advacate call them and ask who that is. Also ask them why they denined it

[JillianRN 0]

Hi Everyone,

I'm new to the forums and was looking for some advice. My doctors office sent in a letter of necessity recently and I have just recieved a denial letter from UHC.

I'm now in the process of research and trying to determine how to appeal. Does anyone have any example letters to share?

The letter specifically mentions they needed a 5 yr history of obesity, so I am in the process of contacting past doctors and trying to put an appeal package together.

My BMI is 38-39, have several co-morbities (high blood pressure, high cholesterol and sleep apnea). I've done all the steps neccessary (tests, studies, 6 month diet program with nutritionist) and this is such a dissapointment.

Any help would be extremely appreciated!

Thanks

Evan

Do not give up. There is an appeal process to follow.When you go to the home page search for the thread called Insurance Denials. Or How to appeal a denial....Once you have everything together with your proofl then you can appeal. I think it is effective to have a writen letter from you detailing what the increased weight has done to your life and how your life could been better, I know I have seen posted on this site...about the above...

Jillian

[perussia 0]

Don't give up appeal. I have BCBS and submitted my paperwork on October 28 2010, called them on the 29 of October and they said I was approved- was less than 72 hours. I was like wow. I'm 5'7 weigh 225 BMI just over 35 but I have diabetes.

[Amanda1982 142]

I have united health care it was a struggle getting the 5

Years of weight history, since I have moved to a different city but I got them. I copied a page out of each record showing the date and my weight. It was easy for me because as a woman we see a gynecologist once a year and I spent 2009-2010 pregnant. Just a note they all charged me anywhere from $10-$12 dollars each since they were giving the info to me not a doc's office. Good luck!!!!

[smartnrse 0]

I too have Uhc and I was denied and had to go to 2nd level appeals. I had multiple requirements that I had to meet and they denied twice even though I met all requirements. I had to write a letter detailing how I met the requirements and resubmit 49 pages of documentation to my husband's HR dept. They reviewed it and uhc claimed they had not received documentation on my 5yr wt history even though it had been sent multiple times and their rep verbalized she had received it. Some insurance companies will deny to keep from paying claims. It took me a year to get approval and the HR dept had to tell them to pay the claim. Don't give up, they are counting on it.

[cunner 21]

Don't give up Evan. That's what they are counting on. I was denied last March and then denied again on my 1st level and 2nd level appeals. Many states also have a final appeal by an independent external review. Mine was overturned at this level and the insurance Co. was required to pay at that point. It took almost a year but I am scheduled for surgery on Dec 28th.

You may want to contact obesitylaw.com. They will review you case and let you know very quickly if they feel they can get you denial overturned. It cost me absolutely nothing other than time and anxiety. The entire appeals process was handled for me. I believe the fees are all paid by Allergan (makers of Lap-band) to the attorneys office. Kelley and Walter are the attorneys and they are great.

Best of luck with the appeal.

[Cocoabean 430]

Google weight loss surgery appeals letter. You will find examples. Also the book Weight Loss Surgery for Dummies has some examples.

On mine, (I no longer have a copy, the computer I wrote it on is dead), I appealed the 6 month requirement. I won by submitting Weight Watchers Records and other personal journals.

You can request a copy of the letter written by your doctor. It might cost you for the copying, but you are entitled to anything in your medical records.

Anything you send to your insurance company should be sent via Fed Ex or certified mail so you have proof that you sent it. Keep copies of everything.

The denial letter should state why they denied you and also contain steps for an appeal. Don't give up, that is what they want. My PCP said that the medical group he was in ALWAYS denies a request for a referral to a bariatric surgeon. If you go away, they are happy.

Best wishes!