Insurance Denied Surgery - Give Me Hope!

[MrsPiggleWiggle 65]

I meet the requirements for UHC - current BMI is 40 - but not the 'extended' requirements you only find out about after you start the process, where I guess you have to have had a BMI 40 or higher for the last 5 years, or 35 w/ co-morbidities. In the last 5 years, my BMI has fluxuated between 39 and 41, and no co-morbidities. I just found out over the summer I am pre-diabetic, which counts as a co-morbidity, which is what led me to surgery.

So, my WLS dr. is going to file the appeal. Anyone had this situation and then get approved? I'm scared! Anyone able to share advice/wisdom/anything??!!

[Coykoi 45]

I meet the requirements for UHC - current BMI is 40 - but not the 'extended' requirements you only find out about after you start the process, where I guess you have to have had a BMI 40 or higher for the last 5 years, or 35 w/ co-morbidities. In the last 5 years, my BMI has fluxuated between 39 and 41, and no co-morbidities. I just found out over the summer I am pre-diabetic, which counts as a co-morbidity, which is what led me to surgery.

So, my WLS dr. is going to file the appeal. Anyone had this situation and then get approved? I'm scared! Anyone able to share advice/wisdom/anything??!!

[Coykoi 45]

I had a similar experience with UHC, they said that it was extra requirements that my employer put on. I wonder if its a choice that UHC gives to employers to lower their costs? I was never able to get it through. Now 7 years later, 30 lbs heavier, & with blue cross, I'm trying again. I hope that they've gotten better at approving during appeal. Good luck!

[abetterme4.2 268]

I meet the requirements for UHC - current BMI is 40 - but not the 'extended' requirements you only find out about after you start the process' date=' where I guess you have to have had a BMI 40 or higher for the last 5 years, or 35 w/ co-morbidities. In the last 5 years, my BMI has fluxuated between 39 and 41, and no co-morbidities. I just found out over the summer I am pre-diabetic, which counts as a co-morbidity, which is what led me to surgery.

So, my WLS dr. is going to file the appeal. Anyone had this situation and then get approved? I'm scared! Anyone able to share advice/wisdom/anything??!![/quote']

Yep, I got denied with them as well. No comorbidities and no BMI of 40 or more for 5 years. Maybe the appeal with pre-diabeties will get you approved.

In the meantime, I will be in Mexico come January getting mine done.

[SLEEVEDNBEAUTIFUL 42]

I meet the requirements for UHC - current BMI is 40 - but not the 'extended' requirements you only find out about after you start the process, where I guess you have to have had a BMI 40 or higher for the last 5 years, or 35 w/ co-morbidities. In the last 5 years, my BMI has fluxuated between 39 and 41, and no co-morbidities. I just found out over the summer I am pre-diabetic, which counts as a co-morbidity, which is what led me to surgery.

So, my WLS dr. is going to file the appeal. Anyone had this situation and then get approved? I'm scared! Anyone able to share advice/wisdom/anything??!!

Stay prayful. I was denied and it has been a long journey. I had the same issues as you but then three later I had a higher BMI with all the bells and whistles. I switched jobs twice and finally got my new insurance to approve me. Your time well come soon. Don't give up or in.

[gtracygilby 15]

I don't have the same insurance but was just denied for lack of weight documentation. Have been seen for several years (18 to be exact) at the same clinic and they didn't take my weight every time. The weights that are on file are under 35 BMI (one being 34.9). I am now in the process of a peer to peer with my doctor and the insurance. If that doesn't work, we will appeal. Good luck and keep us posted!!!

[keya34 46]

I don't have the same insurance but was just denied for lack of weight documentation. Have been seen for several years (18 to be exact) at the same clinic and they didn't take my weight every time. The weights that are on file are under 35 BMI (one being 34.9). I am now in the process of a peer to peer with my doctor and the insurance. If that doesn't work' date=' we will appeal. Good luck and keep us posted!!![/quote']

What is peer to peer with your doctor mean?

[gtracygilby 15]

My doctor talks to the insurance company, one on one, to fight for me to get the surgery.

[keya34 46]

Oh ok that should be good hope it works for you. I am still waiting

[gtracygilby 15]

Thanks.....I hope your denial gets overturned!

[MrsPiggleWiggle 65]

Thanks everyone. I know there is no way my hubby would agree to self pay, so this is my only option. I'm really hoping the appeal will work.

[keya34 46]

Thanks.....I hope your denial gets overturned!

Oh no I am waiting to submit for the first time but good luck to you and pray we both get approved