Insurance denied for no co-morbidities...anyone else? (United Healthcare)

[🅺🅸🅼🅼🅸🅴🅺 296]

Ok, so I just found out United Healthcare denied me because overall I had no co-morbidities. No sleep apnea, hypertension, diabetes, cardio-pulmonary problems, etc.. I've been 5'4 and 225 or higher sice 2001. Right now I'm at 280 with a BMI of 48.1. The girl I talked to at United Healthcare thinks I should appeal with my case and it'll go to a medical director to re-review it. Has anyone had that done and get approved? Thanks in advance, guys :smile2:

[🅺🅸🅼🅼🅸🅴🅺 296]

Ok, so I just found out United Healthcare denied me because overall I had no co-morbidities. No sleep apnea, hypertension, diabetes, cardio-pulmonary problems, etc.. I've been 5'4 and 225 or higher since 2001. Right now I'm at 280 with a BMI of 48.1. The girl I talked to at United Healthcare thinks I should appeal with my case and it'll go to a medical director to re-review it. Has anyone had that done and get approved? Thanks in advance, guys :smile2:

[Futr littl Debi 0]

You should check your policy. Usually, if WLS is covered, it is covered for over 40 BMI or 35-40 BMI with comorbidities. I would appeal the decision. They may be making the decision based on the wrong criteria. I would just point out that your BMI is over 40.

[snowbird 2]

Talk to your pcp too. Mine went over my health history with the proverbial fine toothed comb and wrote up my bad knees (which are actually due to a congenital problem with my kneecaps, which makes them hyperextend easily), slightly elevated bp, slightly elevated blood sugar levels, and acid reflux all as co-morbidities to obesity.

[sahmof3 0]

I have UHC and they approved me in 4 days. I have a BMI over 40, but no co-morbidities that I am taking medicine for yet. My PCP was waiting since I was looking into having the lapband done. He knows they will go away when I lose weight. I have the beginnings of high blood pressure, sleep apnea, and high cholesterol.

They submitted a 5 yr weight history (all years did not have a BMI over 40), PCP letter of support, psych evaluation, and information from the dr doing my lapband. What that letter said I don't know.

Go for it!!!!! :thumbup:

[steph_co 9]

I haven't dealt with insurance a lot. I was self-pay for this surgery. But based on a lot of what I've read on here, it sounds like the first application to insurance is almost always denied. They will find any reason under the sun to deny a claim. Keep appealing. And appealing and appealing. I wish you good luck. You may want to read up in the Insurance forum on the main index - you'll probably find threads just like this one. :thumbup:

[Elisabethsew 50]

Call the insurance carrier and ask to speak with your case worker. This is the person who can best answer your questions and assist you in what is required to gain approval.

[awholenewworld 0]

I too was denied by United Health care however my insurance company specifically has a clause that excludes treatment of obesity.

[socaldixiegal 0]

I have United Healthcare PPO. Each plan can be different based on what you employer provides into their plans (even if you have the same insurance company). However, my covereage does include WLS and with a BMI of over 40 it's automatic. Definitely fight the claim. Talk to your doctor office as well about how much they will push for you as well.

[🅺🅸🅼🅼🅸🅴🅺 296]

Luckily I just found out that the more expensive insurance plan we have to choose from at my job doesnt require anything regarding co-morbidities. We have open enrollement coming up and we can switch. It may be about a month a half though. So, I guess we'll do that. They say things happen for a reason so maybe this wait is...well...for a reaon...LOL

[Happy Loser 0]

Hi I'm new here. I was looking for information about United Health Care. My sister who lives in Missouri is also trying to get the LB and she just heard back from the surgeons office that WLS is not covered by her Policy. She has UHC Choice Plus. Are any of you all familiar with her plan or have any information that might help her. She works for a small business and could have the insurance switched pretty easily she just needs to know what policy to go with. TIA