Next Level

[Heyher 581]

Next week we will submit the final appeal to UHC.

This level is a board of MD that ate not affiliated with UHC. I hope apnea, chronic fatigue, MS, fibromyalgia, and arthritis will be enough to convince these docs that the surgery is needed and an approval is warranted. If this doesn't work, then I'm not sure what to do. Peer to peer did not work and external is final appeal. Can't take out a loan or finance the surgery. No refinancing home loan to get it. Fingers crossed these guys will see its more then just 5 years bmi of 40+. (BMI has been well over 30 for almost 10...)

[Lissa 2,631]

I'm keeping my fingers crossed for you! Good luck with the appeal!

[ladiJ 83]

sending positive thoughts your way!

[Heyher 581]

PCP is writing a letter today stating that surgery would be very beneficial to pain management with fibro and ms. Gunna get the letter today and send everything off tomorrow for external appeal.

[DreamsOfSkinny 53]

Next week we will submit the final appeal to UHC.

This level is a board of MD that ate not affiliated with UHC. I hope apnea' date=' chronic fatigue, MS, fibromyalgia, and arthritis will be enough to convince these docs that the surgery is needed and an approval is warranted. If this doesn't work, then I'm not sure what to do. Peer to peer did not work and external is final appeal. Can't take out a loan or finance the surgery. No refinancing home loan to get it. Fingers crossed these guys will see its more then just 5 years bmi of 40+. (BMI has been well over 30 for almost 10...)[/quote']

Did you do first internal appeal?? That's my next step now as peer to peer was denied. What was the conclusion from external?

[Heyher 581]

I did the internal appeal and got the denial fairly quick.

The external appeal was filed on the 7th and sent forward in the 12th. They have 30 days to decide. I also wrote a personal letter stating the benefits the surgery would have. I showed that this wasn't an overnight decision and that I have started changing my life in anticipation of the surgery.

Hope it works. I will know by 12/12/12.

[AdeleRN 6]

Hi, just wanted to let you know I have UHC and went thru 2 appeals, but was approved last week but the third party MCMC. I have been fighting and jumping thru hoops for almost a year. DON'T GIVE UP! Good luck !

Adele

[Heyher 581]

The theme I get is UHC like to deny, but third parties have no issue approving. Hoping that is my case.

[DreamsOfSkinny 53]

Hi' date=' just wanted to let you know I have UHC and went thru 2 appeals, but was approved last week but the third party MCMC. I have been fighting and jumping thru hoops for almost a year. DON'T GIVE UP! Good luck !

Adele[/quote']

Why were you being denied? Did you write your own appeal?

[AdeleRN 6]

First I was denied because I didn't have 5 consecutive years if documented obesity. The one PCP that had the most documentation had my HT as 5'6-5'7 and 5'8 all on different dates so that changed my BMI and they wouldn't approve it. Then I decided to have a sleep study and was Diagnoses with sleep apnea. I had also been diagnosed as newly hypothyroidism and vit D deficiency. They again wrote stating I was denied , even though I met the criteria. I tried to call and was told it needed to go to MCMC, that was a third party who doesn't work for UHC. They look at all the info and make a judgement based on all the documentation. Yes I did write a letter with the first set of documentation that was sent to UHC. All the documentation kept being copied and sent with each appeal and then to the outside company. Hope this helps. I submitted my 1st application to UHC in march of this year. So be patient. If you meet criteria , you will be approved. Good luck. Adele