Victory! Second Appeal Successful - Surgery Approved - Uhc

[want2bthin 93]

I haven't been here in a few months but I had not given up on getting VSG surgery approved. I've written some posts which tell more of my story if anyone is interested and is going through the same thing:

http://www.verticals...er-suggestions/

This has been such an emotionally draining time that I wanted to share that I have finally had SUCCESS and I thank all of those who encouraged me to keep

trying.

I will be having a Lapband removal and revision to Sleeve - Surgery date not scheduled yet since my surgeon's office said they have to see if any pre-tests will be required.

I was originally denied by UHC in August stating that I had not met their requirements since I hadn't completed a 6 month pre-op physician supervised diet. I was, however, approved for the Lapband removal due to complications. I wanted both done at the same time and found the fact that they approved one and not the other completely illogical. My surgeon's office suggested I move forward to start a physician supervised program (since UHC says it specifically cannot be a Bariatric physician). I started seeing my primary care Dr. specifically for weight loss. I had recently moved to FL so had to find a primary care Dr. to begin with. So essentially I decided to go down both tracks - appeal the denial as well as work on the six months pre-op diet so, in my mind, worst case I would still qualify by March. However, I was still upset about the whole 'principle' - or lack of - principle of requiring someone who lived with the Lapband for so long to do another 6 month pre-op diet.

I sent an appeal letter to UHC and received the most ridiculous response I have ever seen - let alone another denial. They had another Dr. review my case - someone supposedly with knowlege of bariatrics and his lame reason for denying me was that since I had failed with the Lapband I would just fail again with a Sleeve and then I would be asking for a gastric bypass - almost his exact words... no lie. This infuriated me and showed a total lack of knowledge on his part in my opinion. I mean, just like that, this Dr. who does not know me at all, has never even spoken to me, let alone examined me, decides that I am just a BIG failure!!! I was told the next level of appeal would go to my employer since my employer self insures the plan or something like that. In the meantime I continued to go for my monthly Primary Dr. visits and the first few months lost about 5 lbs then after the holidays gained that back and more. I forgot to mention that my Band was unfilled back in July and my appetite has been worse than ever let alone that I can now eat a whole lot more plus things I couldn't eat for years.

It took me another month or so to finally write my second appeal letter which went to my employer. By the time I sent it off it had grown to 70 pages - 2 for the letter and the rest my prior letter, denials and other medical records. The first appeal letter was 4 pages of a letter and 30 pages of records but I went ahead and obtained more records in the interim from my podiatrist, etc.

I didn't intend for this post to be so long - I guess I'm kind of venting along the way so forgive me for that. I finally received a letter from my Employer the other day stating that they, too, had had another surgeon review my case who had bariatric experience and this Dr. (bless him) completed validated my case - stated that both surgeries are absolutely medically necessary and that I was correct in pointing out that UHC's own Bariatric policy contradicted them denying me both times before. I choked up as I read his words - and just praised God for his answer to my prayers!

I don't have a date yet - I am supposed to hear from the Nurse at my surgeon's office on Monday to go over my health questionnaire to see if I need any pre-tests for sleep apnea, etc. I am really healthy other than my morbid obesity and even when I had Lapband in 2006 only had to have a pulmonary test done aside from the routine blood, etc. So if all goes well I may still have the surgery by the end of the month or in March.

All this to say that if you are going through the same type of thing - particularly with UHC - DON'T GIVE UP!!! I'm willing to share my letter with anyone interested - email me if you want a copy.

It's sad that they make us go through all of this; upon reflection it has all the more strengthened my resolve, but will still really unnecessary.

As my plans progress I'll post in other topics.

Thanks.

Susie

[former_vbg 198]

Congratulations! You didn't give up! Welcome to the losers bench!!

[happy1957 138]

Congratulations!! I am sincerely excited for you. I too went through the insurance battle and didn't get approved until my last appeal, it was 11 months from start to finish. It's been a fairly easy ride since. I was approved and 12 days later had my surgery which fortunately has been a text book perfect recovery. I feel your overwhelming excitement. Again, Congratulations.

[DreamsOfSkinny 53]

Can you inbox me a copy of your letter?