Insurance denied me :/

[Sleevefornellie 137]

This gives me hope while waiting!!!!! Thanks everyone!!!!

[Bobbe Schu 53]

I too have UHC and they're most difficult! I was denied for a band to bypass revision; had a peer to peer -- band removal approved; bypass denied; so I've hired Lindstrom Obesity Advocacy. It's worth the money to have them handle this on my behalf because they KNOW what they're doing! 90 percent success rate. Been in business since 1996 and A plus rating with the Better Business Bureau.

[LoreLu 79]

I was wondering why I had not heard a yea or nay from UHC for three weeks. Left a message with my case manager at UHC, and she said the Dr's office hadn't filed for it, yet. A couple calls to the Dr's office and I find that they INTENTIONALLY did not file. The hospital is still negotiating with UHC about remaining a Center of Excellence (a LOT have dropped them because they're so difficult to work with). If they submit and get rejected, it's an additional 6 week wait to start the appeal process! So, after I've been on a medically observed diet for 6 months, I'm now in limbo until negotiations are over. THEN I get to start my 5-week liquid diet to shrink my liver!

[Weighting2BeFree 164]

My surgery was paid for by my insurance because of a hernia that needed to be fixed. I only had to pay my deductible +900 for the stomach removal. You may want to see if you have a hernia. No insurance problems and the surgery center financed everything for 0% interest.

[mshrauger 7]

I just had mine done in Mexico. It was a great experience. I went to the Obesity Control Center in Tiajuana. It is a fraction of the cost in the U.S. And the surgeon is accredited by the American college of Surgeons and the American Bariactic Surgeons. He has taught at Yale and UCLA.

[Bobbe Schu 53]

I was wondering why I had not heard a yea or nay from UHC for three weeks. Left a message with my case manager at UHC, and she said the Dr's office hadn't filed for it, yet. A couple calls to the Dr's office and I find that they INTENTIONALLY did not file. The hospital is still negotiating with UHC about remaining a Center of Excellence (a LOT have dropped them because they're so difficult to work with). If they submit and get rejected, it's an additional 6 week wait to start the appeal process! So, after I've been on a medically observed diet for 6 months, I'm now in limbo until negotiations are over. THEN I get to start my 5-week liquid diet to shrink my liver!

You need to contact Lindstrom Obesity Advocacy. Google them for more info.

[Ae21607 1]

I can totally relate to the point that I gave up on the insurance and decided to pay for it on my own. I know it's not realistic for many people to do this but the process was easy breezy and I didn't have to jump through many hoops to get my surgery done.

[londonbaby82 0]

My insurance is crazy you have to be under Drs care keep an exercise and food journal and go to the dr monthly. After a year they'll review it all and make a choice. I have opted to self pay. It's crazy insurance doesn't realize how this can better your health and they will save money in the long run by not having to pay for long term health issues.

[Bobbe Schu 53]

I implore any of you entertaining the idea of self-pay because of insurance denials or demands to first contact Lindstrom Obesity Advocacy. You can find their contact information by googling them. Please! The initial call is free. These people are here to help us!!!

[amoreno 31]

Don't let them end your fight - PCP writes a strongly worded letter. If your doctor is on your side - mount your horse and storm the castle!

[Bobbe Schu 53]

NEVER NEVER NEVER GIVE UP!!!!

[chubbykinsnomore 4]

Yes everyone is correct don't give up. File a Stage I Appeal. Call them and have them send you a letter which by law must cite the specific denial reason verbiage. Some doctors don't fight hard enough on your behalf so you may need to include your own letter of appeal.

I had to it and wrote a letter and gave it to my doctor to resubmit with their packet. In it I quoted their reason denying it with reasons to grant it.

Have a nutritionist or dr express that your fluctuations in weight are cause for concern and that you are at risk of increasing bmi because you are on the cusp. Make sure everything reflects your unsuccessfulness in maintains weight loss n control.

The practitioner that approves/denies these procedures uses opinion but it is supposed to corroborate with facts. Yours sounds more like an opinion. So be sure in your letter to fight fire with fire and mandate that they reassess your situation based on facts based on criteria not opinion.

It will work out for you just be ready for the battle. I was getting ready go for my third appeal letter and was sleeved finally last Monday.

By the way on each appeal letter write out something asking them to review urgently. If you don't they will make you wait the full turn around time in between each stage with can be from 20-90 days depending on insurance.

Good luck!

[c_minta_1117 3]

I am hopeful for you. If UHC continues to reject your request for surgery despite the fact that you meet the policy requirements for coverage, I recommend filing a complaint with your state's Department of Insurance. All of them have websites and online complaint filing.The DOI is very helpful to consumers (you!), construes policy language in favor of the insured person and requires a response and/or remedy from the insurance company within a fixed time frame. In fact, you don't really need to wait, you could file a complaint now. DOI complaints get insurance companies on their toes. They are state agencies that regulate insurance companies.

[Bobbe Schu 53]

Remember you only get so many appeals! I would contact Lindstrom Obesity Advocacy before I do anything else! You don't want to miss out on an opportunity to do this right!