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Denied :(

Kelly1121

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Kelly1121    26

Kelly1121
Posted

I got a letter from United Healthcare today letting me know I am denied for surgery. My insurance plan requires a comorbidity for everyone - even a BMI over 40. I have GERD, and several 'minor' issues related to my weight, but do not have any major comorbidities. I'll call my surgeon's office on Monday, since I'm sure they received the same notice today. I'm so bummed, and not sure where we go from here. I know I can appeal, but I don't think I'd win because I don't have anything major.

My BP has been increasing every year, but is not high enough for meds. My cholesterol is high, but not high enough for meds. I don't think I have sleep apnea (although never been tested). My recent glucose test had me at 5.6 - the highest level in 'normal'. Again, going up, but not high enough to require interventionI suspect I might have arthritis (long shot - but something is going on and I have auto-immune issues... never thought I'd WANT to have arthritis, but now I'm thinking I might need to go in and see my rheumatoligist that I haven't seen in several years).

Has anyone ever been through a denial for this reason? Think there's any shot of making a case that I'm on track to develop these comorbidities in coming years, so doing surgery now would be best to be preemptive before real issues arise?

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James Marusek    5,244

James Marusek
Posted

Ask the people in your household if you snore at night. That is a good indication if you have sleep apnea.

You may have the option to switch to a more weight loss surgery friendly insurance company at year's end during the enrollment period. Many require co-mordities but others may make their determination on BMI solely. My insurance plan said "clinical records support a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity)".

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KristenLe    5,979

KristenLe
Posted

Ask that your Surgeon do a peer to peer review with United. This is the insurance plans way of hoping you don't fight it and just go away. Ask them to provide you the plan details that indicate you have to have a comorbity with a BMI over 40 and what comorbities count. Appeal it as much as you can. Go to Obesity Action Coalition for some good info and resources. Good luck!

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vandernoordh    63

vandernoordh
Posted

I was denied for the same reason. I'm waiting to do a sleep study as it is my only hope for qualifying with United healthcare. My BMI is also 42 but I do not have a comorbidity (only 1) which is the requirement.

Sent from my iPhone using the BariatricPal App

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Grandma04    0

Grandma04
Posted

I'm sorry to hear that. I went through it for a year. 4 doctors. Testing like you wouldn't believe. Then I found my bariatric doctors. It took a year but the financial personal really helped fought for me . And as of June 28th 2016. I finally got the call I have been waiting for. They finally approved for me to have my surgery. No date yet. But like you I have GERD. I couldn't keep food down. The smell of food made me nauseous. So understand you're frustration , pain, and the pain. No pain pills seem too help

Just keep after your insurance company. Talk to someone in office that might be able to help you. Keep the Faith. God Bless You.

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MadisonsMommy    36

MadisonsMommy
Posted

This is super scary for me. I have UHC and my surgeon sent info over for approval today. I am over 40 BMI with no comorbitities, but the plan clearly states that 40+ doesn't need a a comorbidity. I'm scared they will throw a curve ball at me right at the end and I will totally be devastated.

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vandernoordh    63

vandernoordh
Posted

The surgeons office is resubmitting my request for surgery on Thursday....hopefully it's approved this time.

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gina171    626

gina171
Posted

@@MadisonsMommy ... United Healthcare has so many different versions of its plans, even plans with the same names can be different in requirements from employer to employee..... Don't worry yet, your plan could face different specifics.

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Shrinkinqtpi    202

Shrinkinqtpi
Posted

Me too!!!!

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