UHC Choice Plus Appeal time!!

[kkandrod 1]

Ok, so I got a denial today from UHC because of BMI below 40 and no life threatening co-morbidities. SO, here's what I have going on and would love some successful appeal'ers to please help me know where to start and what to do with this info:

Lower back pain due to all excess weight being in front abdominal area

Hip pain from the same thing

Knee pain

PCOS putting me at higher risk of diabetes, heart stuff and other things and the excess abdominal fat making those risks even higher

Cholesteral trending higher but not on meds yet

Diagnosed Reflux & Ulcer

I also have symptoms of sleep apnea but no sleep study done so I guess I should ask my PCP to order that for me if he will.

Ok, where do I go from here appeal'ers????? Thanks in advance!!!

[kkandrod 1]

So is the following the standard response to the question of how to get an appeal together to the insurance ppl at a surgeon's office? Here is her response to my last email asking that very question:

"Well, unfortunately, we don't unless your high cholesterol gets worse or is not controlled after you start taking medication for it. Which will mean, you will have to take your medication for a month, go back and have labs drawn, have your physician adjust medication accordingly and repeat the labs in another 4 - 6 weeks and it still not be under control by then, only then can i show a "life threatening" co morbidity."

If this is the norm then I won't be aggravated but I guess I just thought they would be a little more willing to help. I mean, she never even said sorry or how bout we help you with financing for cash pay or anything. Just that I was denied and why in the first email and then this when I asked about appealing. I'm a little disappointed :-(

[educationrulz 18]

Did you ever investigate whether an ortho consult would help with establishing a comorbidity?

[pnw218 14]

I had a sleep test in mid January. I had very little knowledge about sleep apnea and had no idea it would likely be the reason I was so tired all day, and often within an hour of waking up. So - I was really surprised to hear that I did indeed have obstructive sleep apnea. The sleep dr also told me that I needed to lose at least 50 pounds ... the same week my back specialist told me the same thing.

That is what led me to pursue the vsg surgery.

Being overweight does seem to be very common with those who have sleep apnea. My gp told me that she also has skinny patients with OSA. Most of what I have read tho suggests that losing weight will "cure" the sleep apnea. Some people here have also said that. I am hoping!!

Good luck! Get the sleep test if you can. Hopefully you will have sleep apnea - so you can get approved!!

[cwalker 12]

could the knee pain be osteoarthritis? I'm pretty sure Lan said her insurance counted osteo and mine does too.Carla