DENIED!

[vandernoordh 63]

I'm so frustrated. My surgery was scheduled for May 4th and I found out today my insurance (UHC) denied the authorization stating that I did not meet the qualifications because I did not have three qualifying health conditions. My insurance only requires me to have a BMI over 40 (mine is 42) to qualify OR a BMI over 35 and under 40 with three qualifying health conditions. I am so frustrated. How do I appeal the denial?

Thanks in advance!

Edited April 28, 2016 by vandernoordh

[dede0314 356]

Can your doctor do a peer to peer review? If not I would call UHC and get information about their appeal process.

[KristenLe 5,979]

I would call and speak to a Manager at United and find out exactly the issue. Then ask your surgeon's office to help with an appeal. There's some good info on Obesity Action Coalition website about appealing. Good luck.

[vandernoordh 63]

Can your doctor do a peer to peer review? If not I would call UHC and get information about their appeal process.

That's what my insurance said I should do. What is a peer to peer review?

[dede0314 356]

It basically your doctor talks to someone from the insurance company to explain why the surgery is necessary. This can get your denial overturned. I would do this first before doing an appeal.

[vandernoordh 63]

It basically your doctor talks to someone from the insurance company to explain why the surgery is necessary. This can get your denial overturned. I would do this first before doing an appeal.

Good thing I'm at work or I would be crying. Thanks for the help.

[dede0314 356]

I know it's upsetting. I fought with my insurance company for months and went all the way through the appeals to an external review. Don't give up, that's what they want. If you meet the qualifications, I'm sure you will get approved.

[vandernoordh 63]

Thank you for your encouraging words!

[vandernoordh 63]

So after talking to the insurance company, even though my BMI is 42, I still have to have a comorbidity, which I don't.

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[Sajijoma 1,324]

So after talking to the insurance company, even though my BMI is 42, I still have to have a comorbidity, which I don't.

Sent from my iPhone using the BariatricPal App

are you sure you don't? Have you been checked for sleep apnea or have light stress in continence like when you sneeze? That can be comorbidity! I bet if you go to your PCP they can find you a comorbidity if they look hard enough. I technically didn't have any, but if I had been tested for sleep apnea I am certain I would have come back with it because I would wake up choking and gasping for air and feel tired in the morning.

[Sumaire 75]

You don't have high blood pressure, sleep apnea, or degenerative arthritis in your spine/hips/knees (dumping the weight can help to slow that down)?

Just a thought...

[KristenLe 5,979]

I would ask for that policy where it states that requirement. That's very unusual with BMI > 40 and what do they want - for you to wait until you're diabetic! That's ridiculous. Fight it!

[Sumaire 75]

Deleted duplicate.

Edited April 28, 2016 by Sumaire

[vandernoordh 63]

Yes I have degenerative arthritis in my back and hips

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[dede0314 356]

Is there anything online that has their qualifications listed? Does it say you need a comorbidity if your BMI is 40 or above. My sister has UHC. I know the plans are different but she was approved with no health issues just a BMI over 40. I would investigate and get all the info I could. I would also still go through with the peer to peer review.