All this crap and now an appeal??!!!! I hate my life!

LynneB · February 12, 2008

:mad::angry:After everything I have been thru, all my Dr did to make sure UHC was going to cover this, my surgery was supposed to be this past Friday the 8th. Well on the 7th ins calls my Dr & tells him they are NOT PAYING!!!!!!! They claim its an exclusion in my contract. DUH YOU FREAKING MORONS!!!!! The exact wording in my contract is "Surgical or non surgical treatment for obesity, including morbid obesity, is an excluded service UNLESS authorized by a physician for medical reasons." 5 yrs of weights, and 4 co-morbidities, 3 different physicans writing in letters of medical necessity and over 100 pages of medical records dont just scream "authorization by (3, not just 1) physicians for medical reasons"????!!!!!!!!! AGGGHHHHHHHHH!!!!!!!! I am so mad and disappointed. I just havent been able to log in for awhile because I just want to cry when I even think about the surgery! I should be healing right now, not still waiting!! So now they required a formal appeal letter and a copy of my contract that states it could be covered if criteria are met to review the decision. You would think the idiots would have looked at the contract before denying it! They are the ins company, they make their own contracts! So now I have to wait at least 15 days for another decision which will probably be another denial in the hopes that I will give up and let them out of it. So the 15 days is up around the 19th or so, and my parents are in Vegas till the 21st and I committed to pet sitting for a friend untill the 23rd so even if its approved I wouldnt be able to have it till the 1st of March which then would put me going to Disney World for spring break when I am still on liquids or at best mushies. This sucks so bad! Why cant things just go my way just once in my life???!!!!!!!!

losingjusme · February 12, 2008

Lynne,

that is so discouraging, but dont give up! do all you can do to get this. it's worth fighting for!

Walter · February 12, 2008

Sorry to hear about the UHC problems...happens a lot more than you would ever believe. Don't forget to ask your surgeon about the Allergan LAP-BAND Appeals Advocacy Program....it is free to you and them and takes the burden off you and makes sure that your appeal is the best it can be.

Good luck to you however you decide to pursue things!

Shalee04 · February 13, 2008

We are also in the midle of appealing UHC, They gave us the approvel I needed with my health issues and sent us those approvel letters. So I went ahead and had the surgery, and wouldn't you know it, NOW they say they wont cover ANY of it... Uhmmm Yeah well be prepared for a fight UHC. So dont give up, appeal and we will all keep our fingers crossed for you....

JDUB0414 · February 13, 2008

I'm so sorry lynne. That sucks. I'm going through something similar. I will pray for us both.

ragdollx19 · February 14, 2008

I am sorry you are having to go through this but I hardly see it as a reason to "hate your life."

There are a lot of users on here who dont even have the slightest chance of having the procedure covered by their insurance either because it is completely excluded or because they dont even have insurance. You are blessed beyond belief to be able to file an appeal and provide the proper documentation so that you can have your surgery paid for.

I am sorry you are so frustrated and disappointed that you havent had your surgery yet but do try to look at the positives in your situation. Good luck getting your approval quickly, in the scheme of things 15 days is NOTHING.

LynneB · February 14, 2008

I put that I hate my life because if it wasnt for bad luck I would have no luck. I know I am blessed in the ability to file an appeal, its not like I am gonna go homicidal or suicidal over this or anything else, but right now, my life seriously sucks, 2 deaths in my family in the last month, my son being diagnosed with muscular dystrophy that is only affecting his heart and he is only 14, my father had a a couple weeks ago, and all that is just the start of things that have gone wrong lately. Being on the 10 day pre-op diet just to have surgery cancelled on the 10th day and now having to appeal and fight is just a small mole hill in the mountain of my life. So yes, right this moment, I do hate my life.