Have not been to Dr. in 3 yrs.. I need 5 yr history

[MyNuLife 0]

I have not been to My Primary Care Physician in 3 years (putting my career b4 my health). My insurance (UHC) requires 5yr medical history. I want the approval for Lap surgery to go as smooth as possible. Is the fact that I have medical records from 2003 - 2004 going to make me have to wait longer. I read so many blogs about the fast approvals for UHC but I have not seen any that have not been to the Dr in 3 years. I have 47 BMI and 2 obesity issues. :confused2:Help!!!

[SherryW 4]

Well I would think if you go to your doctor now for a physical and he/she doesn't see a weight loss since your last visit that that's still a history of care. UHC is probably making sure you've tried every option in dieting or at least tried and failed prior to paying for the surgery. You can always call your UHC rep to find out the specifics as well. You're choice in surgeons/bariatric center also could help you with this in that they probably already know what it is UHC is looking for and can help you obtain it. Give them a call first and then UHC to double check. I wish you the best!

[FinallyFree 1]

Did you not have an annual pap or mamogram during the 3 yrs? I used any and all dr. records I could find for the 5 yr period.

[MyNuLife 0]

Did you not have an annual pap or mamogram during the 3 yrs? I used any and all dr. records I could find for the 5 yr period.

Unfortunatly, I absorbed myself in my job and family for the last 3 years. No paps or No physicals. Taking care of my family and grandkids took control of my life.

Now I am taking control of my life. I have a Dr's appt for Monday and I will get my medical records and have a phyiscal at the same time. Prayerfully, this will be enough.

Thanks for your response. Cross your fingers!!!

[QuasiTova 0]

Like you, I have neglected my health for career and kids and grandkids the past few years. I could only scrounge up 4 actual doctor visits in the past 5 years... three of those were in the same year. I had one in 2003, and three in 2004. That was all. And then I got a physical in 2007 right before my first lapband appointment.

My BMI was 43 (I think). I did not have any other health issues (but I was borderline on some), but I listed EVERY issues that my family members have. I think they look at this a lot, and expect that you might get these eventually if you do not lose the weight. So, I listed TONS of them... everything I could think of.

I also have UHC... and was approved in only a week.

Also, when you go for your physical, have the doctor document weight loss attempts during the two years that you do not have any history. Most doctors will just make a statement saying that the patient says, "blah blah blah". Every little bit helps.

Have you had the same policy for all of this time? I think they can see that you have not gone to the doctor if you do not have any claims.

Good luck

[🅺🅸🅼🅼🅸🅴🅺 296]

Not to discourage you because this will all depend on the specfic UHC plan you have... I was just denied by UHC (my plan is Choice, not Choice Plus). They required the 5yr history and like you I barely had any records. Just a few OB appointments and some Care Now doctor visits for strep throat. Since I didn't have any co-morbidities, I was denied. Even though my BMI has been at or over 40 for quite some time now. My friend has Choice Plus and supposedly co-morbidities are not a requirement on that plan....its also a more expensive plan. A few co-morbidity examples are diabetes, hypertention, cardio-pulmonary diseases and sleep apnea. Pretty much any disease or health problem that can end up killing you. UHC told me I need to definitely appeal but the fact that I don't have documented info with a doctor that I visited them for a health issue cause by being overweight...I don't have much of a chance. I hate to be a downer but I just want you to have as much info as I wish I had. The doctor thing is about the only thing that has screwed me.... I wish you the best of luck though! Did up ANY and ALL doctor records you can think of where they recorded your weight.

**See my other threads about my UHC insurance blunders...

http://www.lapbandtalk.com/f8/insurance-denied-no-co-morbidities-anyone-else-united-healthcare-53119/

http://www.lapbandtalk.com/f17/insurance-denied-no-co-morbidities-anyone-else-united-healthcare-53118/

[MyNuLife 0]

Like you, I have neglected my health for career and kids and grandkids the past few years. I could only scrounge up 4 actual doctor visits in the past 5 years... three of those were in the same year. I had one in 2003, and three in 2004. That was all. And then I got a physical in 2007 right before my first lapband appointment.

My BMI was 43 (I think). I did not have any other health issues (but I was borderline on some), but I listed EVERY issues that my family members have. I think they look at this a lot, and expect that you might get these eventually if you do not lose the weight. So, I listed TONS of them... everything I could think of.

I also have UHC... and was approved in only a week.

Also, when you go for your physical, have the doctor document weight loss attempts during the two years that you do not have any history. Most doctors will just make a statement saying that the patient says, "blah blah blah". Every little bit helps.

Have you had the same policy for all of this time? I think they can see that you have not gone to the doctor if you do not have any claims.

Good luck

This is great news!!! I am looking at your case example as a light at the end of the tunnel. Up till now I was really nervous. Thank you :glare:

How are you doing after your surgery? Do you have any high-protien favorite recipes that you enjoy?

[MyNuLife 0]

Not to discourage you because this will all depend on the specfic UHC plan you have... I was just denied by UHC (my plan is Choice, not Choice Plus). They required the 5yr history and like you I barely had any records. Just a few OB appointments and some Care Now doctor visits for strep throat. Since I didn't have any co-morbidities, I was denied. Even though my BMI has been at or over 40 for quite some time now. My friend has Choice Plus and supposedly co-morbidities are not a requirement on that plan....its also a more expensive plan. A few co-morbidity examples are diabetes, hypertention, cardio-pulmonary diseases and sleep apnea. Pretty much any disease or health problem that can end up killing you. UHC told me I need to definitely appeal but the fact that I don't have documented info with a doctor that I visited them for a health issue cause by being overweight...I don't have much of a chance. I hate to be a downer but I just want you to have as much info as I wish I had. The doctor thing is about the only thing that has screwed me.... I wish you the best of luck though! Did up ANY and ALL doctor records you can think of where they recorded your weight.

**See my other threads about my UHC insurance blunders...

http://www.lapbandtalk.com/f8/insurance-denied-no-co-morbidities-anyone-else-united-healthcare-53119/

http://www.lapbandtalk.com/f17/insurance-denied-no-co-morbidities-anyone-else-united-healthcare-53118/

I really hope your claim lands on a person that is lapband friendly. Thanks for the valuable feedback.

Please let me know when you are approved!

Good LUCK

[QuasiTova 0]

This is great news!!! I am looking at your case example as a light at the end of the tunnel. Up till now I was really nervous. Thank you

How are you doing after your surgery? Do you have any high-protien favorite recipes that you enjoy?

I have UHC Choice too... and mine was approved with no co-morbidities.

I would just list EVERY possible illness that your family members have *cough* or don't have (I did not say that).

I think a lot of times the insurance's decision depends on how well the doctor "speaks the insurance language".

Another girl who goes to my doctor was turned down twice by her insurance company when she was trying to use a different surgeon, but she was approved when she applied through my doctor. I think it is important to find out how much experience the insurance person has at the doctor's office. I have heard that some do nothing more than submit the paperwork, and leave a lot of the communications up to the patient. My doctor's insurance person took care of EVERYTHING.

I am doing fine after surgery... I love my band... except for this past weekend. I have posted several posts about my progress, and some Protein info too.. if you go to my profile and click "show more posts by this person". (I am too lazy to retype everything) lol

Wait, I wonder how many calories we burn by typing?

[MyNuLife 0]

I went to the Dr. and boy-o-boy did I have a long visit. He ran a lot of blood test, scheduled a mamogram and EKG. The EKG came back abnormal and he required me to have a stress test. I did everything he asked and guess what. He approved my request and he is filling out the referral and sending all of the five year history I have (2 years). i am picking up the information and taking it to the Bariatric Dr. in the morning. Keep your prayers coming for me.

[QuasiTova 0]

I went to the Dr. and boy-o-boy did I have a long visit. He ran a lot of blood test, scheduled a mamogram and EKG. The EKG came back abnormal and he required me to have a stress test. I did everything he asked and guess what. He approved my request and he is filling out the referral and sending all of the five year history I have (2 years). i am picking up the information and taking it to the Bariatric Dr. in the morning. Keep your prayers coming for me.

Any NuNews? :sad_smile:

[MyNuLife 0]

Thanks for checkback QuasiTova. I heard the news on March 30th. YES, I am Approved!!!! My pcp wrote a letter and I wrote a letter and submitted them with the medical history. 5 business days later I received a phone call with the Excellent information.

I scheduled my surgery for Monday, April 14th @ 7:45am. They tell me I will be the first one of the day.

Please keep me in your prayers. Kinda nervous the closer it gets to Monday.

[Mom2_4 0]

I have UHC and my records from 2002-2003 were submitted along with records starting in 2007 from my current PCP and I got approved right away. The person I talked to at United said that they wanted to know that you have had a diagnosis of morbid obesity for at least 5 years.

I would schedule a physical with your primary right away and discuss your desire for surgery with her asap. That way you have older records as well as current. It worked for me. Good luck!!