Discouraged. I hate insurance companies!

[sleever427 9]

Feeling really hopeless right now. I feel that I cannot go another day living my life this way as an obese person. My insurance company denied me because they said it is not medically necessary. My comorbidities can allegedly be managed without having surgery. I have chronic pain and nothing has helped. I have high blood pressure, high cholesterol, major depression and sleep apnea. All at age 31. I don't even know where to begin with the appeals process. My surgeon's office is of no help. My PCP is clueless as to how this process goes. My team is not on the ball. It's all up to me to appeal this and I'm so lost. I've never felt this low. Please. Someone help me.

[Beach Lover 1,084]

I am sorry that you are having so much trouble with your insurance company. Do you have the coverage on your insurance policy to have bariatric surgery? If not, there is no amount of comorbidities that will make it happen. If this is the case then you would have to be a self pay as I was. If you do have the coverage and your surgeon's office isn't willing to help then you need to seriously get a different doctor. That is the start of a surgeon's office that I wouldn't want to deal with. Look around for a different doctor and see if they are willing to work with you. If you have the coverage don't stop looking! Best of wishes!!

Edited December 27, 2013 by Beach Lover

[Mrs.RRn 2,111]

You might need a new team.

I'm not familiar with this insurance process as I was a self pay. But I'm sorry you're having to go through this. Don't give up!

[southernsoul 773]

I would get on the phone with the insurance company & make sure I understood exactly what the requirements are in order to be deemed "medically necessary". Is it being above a certain BMI? Are certain comorbidities seen as more serious than others? You need to understand what kind of coverage your company has chosen, because it's up to each employer to set the rules for what's covered, not the insurance companies. Also, you might want to check with your HR department, since the new calendar year will mean policy changes for a lot of people. And I agree with Beach Lover...your surgeon's office should be more helpful. Check your policy to see what other bariatric surgeons are covered & consider going to another one.

[BellaHugz 331]

Oh girl you are preaching to the choir!! I too went through all of this, and it was a hard road I am not going to lie to ya.

At my last visit to my doctors office I realize something Insurance companies do not care about your quality of life, they do care about the $$ and it is so sad. So if you are still fighting mad for your own health you may want to try getting a lawyer. That is what I had to do. http://wlsappeals.com they have different prices and really do help. So do your research and see if it is a fit for you. Hang in there and remember you are worth it!

[sleever427 9]

Thank you everyone. Bariatric surgery is covered by my insurance. I've heard that uhc are really sticklers. They also said I didn't meet the 5 percent weight loss requirement. I actually did meet it in month 5 but then gained a little back in month six. I thought that would be good enough.

[Heyher 581]

I have UHC and it was a nightmare. My requirements were different. Appeal. Appeal. Appeal. Call your UHC customer service and find out exactly why you were denied & what needs to be done. Keep working the program that they have and resubmit. Never give up hope.

[sleever427 9]

Can you expand on that heyher? Why was working with uhc a nightmare? Why did they deny you? How man my times did you appeal? Any info is helpful and greatly appreciated.

Thanks.

[Heyher 581]

I had to be at a BMI of 40+ for 5+ years. I didn't meet the requirements. I went through the whole internal appeal and made it to an external appeal and ended up paying for the surgery. I have a self funded plan and asked my employer for an exception. Was told no. My coordinator said my plan was one of the least accommodating she ever worked with. I was so stressed I got shingles on my face and ended up delaying my surgery by three weeks. But I read a lot of people on here who had great success with the UHC appeals. My plan sucked butt.

[sleever427 9]

I'm so sorry to hear that. Thankfully you eventually got it covered.