UHC BMI REQUIREMENTS KEEP CHANGING!

[2bfit 62]

Has anyone heard of UHC *** requiring a BMI of 35 or over with one comorbidity for surgery? I was denied for the surgery stating that I need to have one comorbidity to qualify.

However, when they first denied me for my consultation they indicated that I had to have a BMI of 40 OR a BMI of 35-39 with a qualifying comorbidity. That was the letter from the medical group. When I appealed the consultation denial to the insurance company I received a letter from UHC stating the same thing BMI of 40 OR a BMI of 35-39 with a qualifying comorbidity.

Now all of a sudden the game has changed? They clearly left out the part of the BMI being 40 or over on my most recent denial for the actual surgery. I have 2 documents from them on their own letterhead stating that a BMI of 40 would qualify if medically necessary. I guess that's what I will have to go after them with for my appeal to try and get the surgery.

UHC has my appeal as of right now so I will probably have to wait for 30 days until I know something. Right now I am finishing up the 3 required visits with the NUT and I did meet with their weight doctor as well. He wants to put me on a Medifast program but my NUT is absolutely against it. She is going to document her reasons why going on Medifast again will not work for me. So at least I have her in my corner.

So now I sit and wait again.... Does anybody out there have UHC West (formerly Pacificare ***) with Sharp Community? What did you have to do to get approved? My surgeon wrote up the surgery request indicating that I was morbidly obese and that he was recommending that I have surgery. My PCP also indicated that it was medically necessary. I don't know what else to do!

Help!

Thanks,

Cheri