Uhc Denial For Revision

[SKINNYBY40 0]

I was just wondering if anyone else has had an issue with United Health Care Choice Plus denial of revision from lap-band to vertical sleeve? I have had complications for two years with gastritis, dyphagia, ulcers, esophageal dilation, and pouch dilation. I also have a hiatal hernia that by new doctor thinks should have been fixed at the time of my lap-band. My BMI is now 35 with several co-morbidities (sleep apnea, post Heart Attack, coronary artery disease, osteoarthritis, ischemic heart disease, sick sinus syndrome, pacemaker, now on beta blockers, etc...). I meet all of the criteria for revision but they just don't want to pay for the revision to the sleeve. First, they stated I did not meet the weight requirements. Appealed and now they upheld their decision stating it was not a medically necessary. I have one last appeal but really don't know what to do to change their minds. I do know that it will go the someone who has never looked at my file and had nothing to do with the original denial or appeal. Any suggestions to help get this approved? Any sample letters out there that anyone knows about? Sorry this was so lengthy! Thanks for listening!

[joyful noise 101]

Can't your surgeon's office and your PCP help?

[SKINNYBY40 0]

PCP is going to write a letter of medical necessity. Apparently, UHC did not even look at my heart issues on the last appeal so I might have a chance for approval. The problem is simply converting to a sleeve rather than revising the band.