Denial?! [emoji54][emoji24]

[Mysticpink74 50]

I Can't believe it...I have sleep Apnea, Acid Reflux, I weigh 310 (327 starting weight at 5'0" so over 44BMI), chronic back/knee pain that I go to pain management for and take Vicodin, Clinical Depression, & I got DENIED from surgery on 8/24! I put an appeal in (over the phone w/ a UHC operator) on 9/1...so hoping it gets turned around... I still have not got the denial letter so I don't know why I got denied! UHC told me my provider would let me know or Last I spoke they hadn't received a reason but told me I'd get a letter...but I haven't gotten a letter yet...

I don't understand how I got denied?! I thought I had plenty to be a shoe in?! I'm so frustrated I was so looking forward to getting in August surgery date... I don't know how long the appeal will take but now I have to wait that much longer...

Any one have tips to turn this around or know how long it takes for an appeal to be turned around? Or if there is a chance that I'll get DENIED again or think I'll get accepted w/ all my co-morbidities....I mean is it just a routine thing that they deny you at first, to see if you'd never try to make an appeal?

Lmk....TY

Sent from m

[dhrguru 1,238]

From what I read here, you technically only have one co-morbidity-- apnea. The "usual suspects" for co morbidities include high blood pressure, diabetes, or high cholesterol and apnea. Depression and joint pain aren't co-morbidities, since neither in their own can kill you (debatable I know)

What was your insurance requirements? I think I would review the file with your surgeons office before the appeal to see if everything was submitted. Sometimes it's just a case of something not being received. Definitely File every appeal you can.

[Mysticpink74 50]

Ty! Will do... & not sure how to look up requirements for my insurance I'll call & ask....????

Sent from m

[James Marusek 5,244]

Ty! Will do... & not sure how to look up requirements for my insurance I'll call & ask....

Sent from m

Many have their policies on-line. Do a search on the health insurance company. Then when you find the company, see if they have the current policy plan available on-line. Go thru it and find the area that deals with bariatric surgery.

[JayVSG 21]

Call your insurance and ask, my insurance company didn't offer gastric sleeve (bariactric surgery) even though I am obese it just wasn't part of my plan, I ended up going on my wife's insurance and they covered it

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[cuteNATL 93]

Sounds like each insurance company is different. With mine, you just need a high BMI or 1 comorbidity and they approve you. Hope it works out for you sweetheart!

[rebelchelz 52]

Mine was approved but I changed surgeons because new surgeon was in network but it was denied because hospital wasn't a blue distinction center. Now found new surgeon in network & at proper facility. Insurance can be very finiky.

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[KristenLe 5,979]

@@Mysticpink74 You need to find out why you were denied first. It may have been incorrectly submitted or missing info. You have a high BMI (over 50) and usually don't need a comorbidity. There has to be another reason. Did you meet all of their preop requirements?

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[Mysticpink74 50]

@@Mysticpink74 You need to find out why you were denied first. It may have been incorrectly submitted or missing info. You have a high BMI (over 50) and usually don't need a comorbidity. There has to be another reason. Did you meet all of their preop requirements?

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Yes I met all requirements & even got a letter from my surgeon saying "Congrats you've met all requirements needed for you UHC insurance" then it went on to say it would take a few days for the nurse to write up something & submit it to my insurance ...I waited a week & called and.....well...you know the rest

Sent from m

[perksgirl 18]

I also have UHC and I have all the things you mention I was approved in two days being sleeved Tuesday

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[Shi-Shi80 73]

I have UHC as well and I'm wondering if it's the surgeon that's the issue. Is your surgeon's practice considered a "Bariactric Center of Excellence" because that was necessary for my insurance? I know each company has its own criteria but my UHC provider required my surgeon to be part of this and I had no issue with getting approved. Check and see if that's the issue.

[Mysticpink74 50]

I have UHC as well and I'm wondering if it's the surgeon that's the issue. Is your surgeon's practice considered a "Bariactric Center of Excellence" because that was necessary for my insurance? I know each company has its own criteria but my UHC provider required my surgeon to be part of this and I had no issue with getting approved. Check and see if that's the issue.

Will do!

Sent from m

[Mysticpink74 50]

I also have UHC and I have all the things you mention I was approved in two days being sleeved Tuesday

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lucky girl ...hope this appeal goes fast! Cuz me & my fiancé jst set our wedding date for 4/1/17 (his bday) & obviously I want to lose as much as I can by then!! ????

Sent from m