UHC DENIED - Need support

[LosingIt08 0]

So I need you all more now than ever

UHC denied me yesterday because they want more of a documented wight history. I have been seeing my doctor since 2003 and he wrote I have been overweight for 15 years.

The Drs were so sure I was getting approved they were in shock, soooo I had to ask my Dr to write a specific letter or update the old letter that I have had a BMI of 40 plus for 5 years.

Thats what they want UHC people.. documented BMI for 5 years.

I have 2 co-morbidites, polycystic ovarian disease and diabetes (discovered during bloodwork for surgery) Did the nutritional and psychological consult, EKG and Chest Xray.. guess theywant my firstbiorn now too (when I have one.. if I have one PCOS doesn't help!)

Even the reps at UHC could not answer why I did not get approved and they all think the medical reviewer guy is being a pain.

ARRRGHGGG

[Southern Missy 1]

LosingIt, you're going to be A-OKAY. I wanted to thank you for the good chuckle you gave me on them wanting your firstborn. However, you have all the history, girl, and they are going to have to approve you. At least you're not like me and screwed up your 6-month diet by not even going in December! I feel positive you'll be posting your surgery date on here in a minimal amount of time. I'll be looking for it! In the meantime, keep your chin up and keep fighting!

[Southern Missy 1]

BTW, further on in this section of threads, CountingtheDays had to appeal 3 times before she was approved but she also had UHC. You might talk with her and see what made the difference. Just a suggestion...

[🅺🅸🅼🅼🅸🅴🅺 296]

I'm going through the same crap with UHC as you are... I'm being resubmitted for a THIRD time today...oh yeah....its been a battle, but keep up the confidence. I could've sworn UHC told me diabetes was a co-morbidity and should be an automatic qualifier. I think they just wanna make us fight! Good luck to you!!!

[ColoradoChick 33]

UHC is hoping that you will just give up and then they get off the hook for paying. They are in the business to make money not promote good health so the more they deny the more they can report on the bottom line. imho Hang in there and just appeal them into submission!! :biggrin:

[LynneB 0]

DO NOT GIVE UP!! I can send you a copy of the 3rd appeal letter I sent to them that finally got me approved if you want. UHC is notorious for hoping you will go away and give up so they dont have to pay. It took almost 3 months of fighting to get them to overturn the denials. The final step after the 3rd appeal is to get your Dr to call the medical director at UHC for a "peer to peer review" in which your Dr has a conference call w/ their Dr to try to convince them to cover it for medical reasons. Surprisingly that call was scheduled but never had to happen since they approved it 2 days before the conference. Just send me a PM w/ your email if you want a copy of the letter that you can revise to fit you. Good luck & stay positive!

[LosingIt08 0]

Thanks everyone, keep the good advice coming I am so frustrated :smile2:

[Chelle30 0]

Hi...I am currently waiting approval from UHC-TN. I was told that a response usually comes in about 72 hours. A friend from work has the same insurance and was approved the 1st time for the gastric bypass. I am sorry to hear of your struggles to get approval. Definitely don't give up!!

[Shalee04 7]

I am in the process of appealing UHC They approved me with my letter from my PCP and because I have been overweight for years and have Comorbittities. I was approved in Oct 07, and they sent me and my Dr's per-approvel letters, and I also called them 2 times just to make sure I was approved....I had my surgery on Nov 12, 07... And what do you think these punks are doing, yep you guessed it, they denied the claim.. said my policy doesn't cover weight loss surgery, when in fact it does, and they also preapproved... so yep I hate UHC right now.... But I am glad I had the surgery, and have lost 45 pounds so far...

So don't give up!!

[LynneB 0]

losingit08 did u get my pm w/ the pasted letter? my comp has been really screwey lately!!

[Kelgirl68 0]

WOW... wonder if it has to do with what plan you have with UHC. I was approved the first time with no hassles what-so-ever. Other than problems with my back I had no other health issues. No high BP, low cholesterol and sugars are great!

Good luck to you!!!

Kel

[Dropping110 0]

I have UHC and UHC is very strict on what they want. I have been overweight for 15 yrs. I had to be under a Drs. supervised diet for 6 months. If I had missed once it I would have had to start over. Because of my schedual I even had to weigh in the day after Christmas. (I gained like 10 lbs) LOL. Then I had to get a psych evaluation and the Dr. took like 3 weeks to get the info back to UHC because of all the paperwork they required. This was all very tiring on me and mentally draining. A couple yrs ago a girl I work with had the Surgery with UHC and it was like a month long process instead of the 6-8 month process it is. I am sure the reason for the 6 months of weigh ins is because they figure within the 6 months you will either

1) Miss weigh in with the Dr. and they will make you start over.

2) You will no longer be with the company you are with.

So basically I went in with a chip on my sholder and was going to show them and keep my job and show up all 6 months for weigh in.

Once you do get approved UHC is very good with aftercare and making sure they follow up with you

Ryan

Banded 3/4/2008

[elle 1]

I have Aetna and they are also strict about documentation. I had to start a new weight loss program with my doctor. Go every month to get documented weight, blood pressure, exercise program for 6 months.

I also had a letter of recomendation from my doctor why I was a good candidate for the surgical weight loss program. Also I had to have a letter documenting my weight for the last 5 years (basically one weight per year to prove that I was Morbidly overweight for last 5 years). I think i was approved within 4 weeks. I had the psych eval, medical check up, blood work already done. My doctor's office has a check list of documentation that you have to provide before you meet the doctor. Then they tell you specifically based on individual insurance companies, what else you have to provide. I did not deal with the insurance company at all. The doctors say that the insurance wants you to jump thru these hoops with the hope that many patients will give up. Hang in there because you will get there. Good Luck.

[Wheetsin 714]

...in the meantime, start visiting your doctor specifically for treatment of obesity. That way, you'll soon have more medical documentation and can resubmit. Call and ask what their documentation requirements are and why yours did not meet them.

[jbflorida 1]

Is there an APPEAL FORM or do we write our own letter to appeal? Should I include the doctor's letter with mine, or do it separately?