UHC - Appeal

[bamagirl36526 0]

Has anyone won from an appeal with United Healthcare??? I have United Healthcare Choice Plus and I was denied getting ready to appeal and was just wandering if anyone has had any luck with this???

[pamla68 1]

Has anyone won from an appeal with United Healthcare??? I have United Healthcare Choice Plus and I was denied getting ready to appeal and was just wandering if anyone has had any luck with this???

I have some notes that I can send you, what was the reason for they gave for the denial?

[bamagirl36526 0]

It was a plan exclusion and my company rep told me to appeal it...any information would be greatly appreciated

[pamla68 1]

Visit this website and you should get a good start to your appeal.

http://www.obesitylaw.com/faq.php

[MS_mom_1965 0]

My denial was because I didn't have enough documentation of my 5 year weight history. My question is this - the policy states that I should have a BMI of 40 or greater for the five years. I do not. However, I do have a BMI greater than 35 with high blood pressure ( a co-morbidity). Is there any need to try appealing the denial? Is the 40 BMI for five years an absolute?

[pamla68 1]

Also there is very good information for you on bandstersinsurance which is a yahoo group. Join and there are several sample appeal letters to assist you.

[Annie 0]

My denial was because I didn't have enough documentation of my 5 year weight history. My question is this - the policy states that I should have a BMI of 40 or greater for the five years. I do not. However, I do have a BMI greater than 35 with high blood pressure ( a co-morbidity). Is there any need to try appealing the denial? Is the 40 BMI for five years an absolute?

Hi MSmom,

I was hoping you could tell me more about your experience with UHC.

I have UHC Choice plus, its a federal employees plan.

I have started all the preop requirements, and have my consults next week. Then the surgeons office will submit to insurance. I worry they will find some reason to deny it. I too havent had a 5 yr hx of BMI over 40. It's been over 35 and I've had HBP too. So reading your thread has gotten me a little nervous. I'd like to hear how your experience was, and what all happened.

thanks!

[CoolBrze198 0]

Hi MSMom & Annie,

I too have UHC Choise Plus.. I haen't had BMI of 40+ for the 5 years. I have been anywhere from 34 - 41. I had HBP a few years ago. And a boarderline diabetic.. But nothing other than that.

My Dr's office just submitted my paperwork to Ins. I am so very anxious to hear the outcome. I will post on here as soon as I know.

I called them friday afternoon and was told it was still in review.

*Keeping my fingers & toes crossed*

Good luck to the both of you as well.

[CoolBrze198 0]

I have some notes that I can send you, what was the reason for they gave for the denial?

Could you send them to me as well? Please.

Grrrr.. I am so angry.

I was told that I didn't have a BMI of 40 or more for 5 years. Which I knew I didn't. But I have had 40 BMI for the last 3 years and as they can see if they looked thru my past 5 years of medical records that I can lose but I can't keep the dern weight off.

So I will be appealing.

Anyone have a situation like mine & appealed and won??

TIA,

Rosanna