UHC denied RNY as experimental

[AcctInTX 3]

I'm scheduled for my RNY on 5/18. This morning I found out that UnitedHealthcare has denied my surgery as experimental. I've filed an appeal but have been told it's unlikely to be approved.

My reason for surgery is not weight - I have gastroparesis. I need this surgery. It's the only viable fix for me, but because my insurance plan says no bariatric procedure, that's it, or so I'm told.

Amy recommendations? I need this surgery. I've gone through all the testing because the first time my Dr's office called the insurance they were told yes, go ahead, I'm covered. Now surgery is denied.

I'm sick to my stomach, heartbroken, nervous. I hate this. I just want the surgery.

[catwoman7 11,212]

Yikes. It's not the surgery itself that's experimental - it's for this particular purpose. I know the surgery is good for diabetes, too - regardless of weight - but that's also probably considered "experimental" when done only for that purpose. I'm not sure what to say - I'm sure this is heartbreaking!

[Recidivist 1,141]

I got bypass for standard weight-loss purposes, but my insurance company denied coverage initially. I had the doctor call the insurance company directly to explain the medical necessity of the surgery. That did the trick and I was approved. Perhaps it would be worth a try in your case.