Soooo Frustrated--Uhc Vs. Dr

[kmb67 14]

Heard from the Drs office today that my insurance denied my surgery and then denied me after the peer to peer review. I cant' get to the bottom of the issue. The Drs office is saying that they have done everything the insurance has asked. However, the insurance called and requested information from the Drs office 3 times. The "only" person that handles bariatric surgery was out of the office for 6 days, and no one else could send it in apparently, so that was the first reason I was denied (lack of paperwork). Last Friday they were supposed to have the peer to peer review, but the Drs office said the insurance medical director called early and he wasn't available, so it didn't happen. The insurance company is claiming they talked to the Dr and he had no new information to submit, so it was denied again. I have no idea WHO to believe!

They now want me to go through the Lindstrom Obesity Advocacy to submit an appeal. I've seen a few good things about them, but still can't help to think if the Drs office had been on the ball, none of this would have happened. I did check with my insurance company (UHC) who initially told me they cover LapBand for a BMI over 40, and no co-morbidities were needed. My BMI is around 44. so I fit into the range.

I was hoping to be a Nov Bandster since this was started on 10/3, now I don't know if I'll ever be a bandster :-(

[2muchfun 8,927]

Never give up. I went through 3 different insurance companies before I finally got approved. Took about 1 1/2 years. I was covered under my wife's policy and the first policy covered it but wanted a 6 month nutrition program. That took me beyond Dec 31st 2010 and the employer dropped that policy completely. Her new policy covered it but then she left that employer in March of 2011 for another job. Fortunately the new job covered the surgery but needed a 6 month nutrition counseling again.

Sucks don't it?

[kmb67 14]

Thanks for the words of encouragement 2muchfun.

Your post brings up an interesting point--I wonder if I'm better off going through the appeal process of changing insurance carriers? We are going through open enrollment now, so I can switch from UHC to BCBS as of Jan. 1st.

Does anyone have any advice one way or the other?