UHC DENIED - Need support

[Wheetsin 714]

Typically you would get instructions for appeal with or shortly following a denial. If you didn't, contact your insurance company re: the appropriate process for filing an appeal.

[babedoe4 5]

Hang in there!!! We all went through it. Some easier than others. I was Aetna too and had to document 5-6 years back and had a 5 mos waiting period. Just plug through and it will come. It will be approved before you know it. It is such a common surgery now that a lot of the insurances try to do it to avoid paying by weeding out those that are borderline or not candidates.If you get a denial after all this, consider switching insurances if it is available to you. A girl at my job switched just ot have the surgery as her prior one didn't even cover bariatric surgery.:sneaky:

[JanetBP 16]

Hi all,

i have UHC also and in my coverage documents it specifically excludes bariatric surgery even for morbid obesity. it actually excludes EVERYTHING related to weight/dieting of any kind. i didn't even bother to try and get them to pay...should i have? i raided an IRA and am paying cash. i'm going to feel like a total dummy if i could have gotten this paid for!!! :drool:

my surgery is a week from tomorrow and i am SOOO ready.

Janet

[babedoe4 5]

Janet,

Obviously you looked into it thoroughly. Good luck with your procedure. It will be money well spent. They won't even pay on appeal if they have a bariatric exclusion. See you on the loser's bench.

[JanetBP 16]

Janet,

Obviously you looked into it thoroughly. Good luck with your procedure. It will be money well spent. They won't even pay on appeal if they have a bariatric exclusion. See you on the loser's bench.

Well good! I feel better. :banghead: I thought if all these folks were getting OKed on appeal maybe I was missing something. Thanks!

Janet

[jbflorida 1]

I went to a seminar tonight and was told that if there were insurance exclusions and NO mention of medically necessary--to call Human Resources at my employers' and ask why they exclude this. THEN ask if they would allow YOU to purchase a rider on the insurance that would permit weight loss surgery. It's worth a try.

I will not be using that surgeon/practice that I visited today. Sometimes you just get a bad feeling. The patient coordinator seemed put out that I was asking questions; she seemed impatient. So....bye! I have learned so much from all of you and can speak "intelligently" about the band. It was amazing to me how many people were at the seminar and knew nothing! One lady declared that she wants to look "gooooood" and she doesn't care about the rest of it. Then she asked when it is taken out.

I think she is in for a surprise!

[amsderb 1]

I have UHC too and have been waiting...My plan is self funded with a trust from my work so they are like the providers....I had several very specific criterias...they told my dr office that there was NO coverage when I had given the doc's office a copy of the exclusionary policy...which I fit. At the time my only concern was if banding was an option since it said " stapling and bypass". As it turned out, I talked to someone at UHC in the "reconciliation" department ...sound Catholic to me lol .... She was very encouraging and got on a conference call with my doc's office. This was just for the initial consult!!!!! Anyway, then the luck and Lord was with me because I talked to my Benefits director,,,just to find out if banding had been covered or appealed....and was told as of 3/01/08 it would be included in the language!!!! Then, we were given the name of a claims person at UHC to send my file through so it wouldn't be held up due to the new language...that was as of 2 weeks ago...still waiting....

That's my muse!

[LosingIt08 0]

I was denied again. They want a documented 5 years of morbid obesity, whatever that means.

I have called and called and all they do is give the the run around and wont even tell me exactly what they want...

WTF!!!???

[amsderb 1]

I was denied again. They want a documented 5 years of morbid obesity, whatever that means.

I have called and called and all they do is give the the run around and wont even tell me exactly what they want...

WTF!!!???

OK I am not a claims person so this is just from my experience...

The 5 year morbid obesity documentation for me was getting clinical notes from Dr...(I used my OBGYN since I was there at least 1 to 2 times a year) Unfortunately, 2 of my doctors had retired and the notes were put in wharehouse storage,,,even though I had signed for them to be sent to my "new" docs...

At any rate....I got copies of my files from prior docs...Urgent Care...Primary....Physical therapy...anywhere that I had a recorded weight. I was fortunate to go back the 5 or so years by getting all this.

Think hard of any dr. that you might have seen where your weight was recorded....Like I said...it wasn't easy for me because in 2005 several of mine retired.....

I know I hated being weighed at those visits but it sure paid off!

Good Luck

[chillie 0]

I was denied again. They want a documented 5 years of morbid obesity, whatever that means.

I have called and called and all they do is give the the run around and wont even tell me exactly what they want...

WTF!!!???

the same exact thing happened to me with the same insurance... the only documentation i had was when i was 2,12, and 17 ( mind now that i am 22) but they denied me twice. My Dr said they worked with some law advacates stationed out of California. They had a site too called Obesitylaw.com, my dr sent my case to them and 1 month later i was approved. You could check to see if your dr offers anything like that or check the site and file your own case . It didnt cost me anything. Hope this helps