APPROVED FOR SURGERY!

[2bfit 62]

After months of waiting I found out today that United Healthcare overturned the medical groups decision that denied my surgery! I am finally approved. I am so flustered right now I can't even think straight! I started this process back in July. My BMI was only 39 and I was denied for the consult because I did not have a qualifying comorb. In Sept I went back to my PCP and my BMI was 41. I was denied for the consult stating I needed to show motivated attempts for dieting for 6 months. I submitted the medically supervised weight loss program I was on for 2 years and was finally approved for the consult. Then the surgeon requested the surgery and I was denied citing I needed to have a BMI of 35> with one qualifying comorb. Problem was they were quoting a Medicare plan and not my specific evidence of coverage. I appealed and today I won! BIG HAPPY DANCE!

I have an appointment to have my pre-op paperwork with my PCP on Thursday. I will have to request a referral for a psych eval at that time. Tomorrow I meet with the NUT for the 2nd visit and will only have one left after that. They are going to require labs, ekg, chest xray and a medical clearance from my doctor as well. I am hoping to get all of this done so that I can have surgery at the end of this month! Wish me luck!

[Living again 11/17/2011 40]

Congats and Good Luck! i am waiting also!

[Living again 11/17/2011 40]

Which UHC you have I have the Govt nyship?

[2bfit 62]

I have United Healthcare H M O Signature Value Advantage in So Cal. Thank you for the good wishes. Be your own best advocate because they are hoping that you will go away. Get all of your paperwork in order before submitting for approval. Try to get as much documentation together as possible!

[M2G 1,836]

Congratulations!! I'm so happy for you!

[Living again 11/17/2011 40]

OMG good luck I am so happy for you ! I cant wait for mine I pray and pray!

[Living again 11/17/2011 40]

I just got call uhc has my papers and its good they said they sent it to cob i am so so happy I should know by Friday!!!

[2bfit 62]

hang in there!

[want2bthin 93]

I was denied by UHC PPO - I am a band to sleeve revision. I was approved for my Lapband to be removed but not for the sleeve since they said I didn't have the 6 months pre-op supervised diet. That is such a crock because living with a Band for 5+ years restricted my calories and I went through the whole process way back then for WLS. In any case, I just sent in my Appeal Letter on Tuesday and should hear in a couple of weeks so I appreciate prayers and positive thoughts from those who have gone through this before.

Just wondering if those of you with UHC were denied through Optum Health - seems they use them for their Medical Reviews. The people there were nice and understanding on the phone and really encouraged me to Appeal so I hope that's what it takes. Silly me I really went into this thinking that if they approved the Lapband removal there was no way they wouldn't approve the revision to the Sleeve. I started the pre-Op diet after being denied right away as a back up plan so worst case I hope to be fully approved by mid February.

2bfit - Congrats! So happy you were approved.

Raquel - I hope you hear the same news on Friday - keep us posted.

Thanks.

Susie

[2bfit 62]

that just stinks! Why in the world would they require a 6 month diet? Good move on starting one now. I hope that they overturn your appeal. You just never know with the insurance companies. Sometimes you get people who know what they are doing and then other times you get those that really should not be involved with the medical field.

I have heard of people getting approved if there are complications with the band. Do you have any that can help with your appeal?

As for me,I am trying my best to get a hold of a psychologist to schedule an appt. It is turning out to be a challenge. I have left messages with 3 different places. So whoever calls back first is going to be who I see!

Hang in there and keep us posted. Look under the revision forum on this website and see if anybody can give you an idea of how they got approved. I know someone there can definitely help you!

Cheri