Denied again by united healthcare, need help

[tcbeau 0]

I have been trying to get banded since 4/15. I had a BMI of 38.4, polycystic ovaries, and high cholesterol of 210 without meds. I was denied because I had no co-mobities, UHC said I needed to be on meds for high cholesterol to consider it a comorbitiy. My PCP wrote a prescription for cholesterol meds and my BMI is now 39. I just found out today that I have been denied again. They said they could not give me a reason, a letter was forth coming. I have been waiting for the answer to my appeal since 5/27. Me and my doctors office have spent many hours on the phone. I am completely CRUSHED!!!!!!!!!!!!!I do not know where to turn now. Any suggestions would be helpful. I think I read something about obesity law, anyone know about that. Thanks alot, this site has been very helpful since I started my search in March of this year. Hope to get approval and surgery soon.:thumbs_down::thumbup:

[Flowerpurr 0]

Yes I have heard wonderful things about Obesitylaw.com and I would try them. But if you like email me at Tazz7722@aol.com and I can send you an appeal letter that you can try first.

[auntlucy 22]

I also have United Healthcare. My BMI is higher, but other than that, the only problem I had was with sleep apnea. Have you had a sleep study? While I hope you don't have apnea, it might help you get approved. I was approved in less than a week.

Good luck! I know how frustrating it is. A few years ago, I tried to get approved and was repeatedly denied by Aetna. So, I understand.

[Great2BThin 5]

I have United Healthcare too, but I had to do self pay, they wouldn't budge. Mine was an exclusion of bariatric surgery. Had no choice in insurance either it is the only company that DH's job offers.

[Walter 0]

My name is Walter Lindstrom and our site information is Obesity Law and Advocacy Center. I am a "banded gastric bypass patient" meaning I had gastric bypass in 1994 and a LAP-BAND placed over it in 2003. I know what you're going through.

If you are having a LAP-BAND (as opposed to a REALIZE Band) you may qualify for Allergan's LAP-BAND appeals/advocacy program. There is NO COST TO YOU for this program.

Here's how it works, and it's really pretty easy:

1. Please contact your LAP-BAND surgeon's office and ask them to get an Appeals Application for you. They get it through a provider hotline number. You are not able to get the Application on your own; the surgeon's office must be the ones to start the process.

IF YOUR SURGEON'S OFFICE DOESN'T SEEM TO KNOW ABOUT THIS APPEALS PROGRAM (SOME PRACTICES ARE LESS AWARE OF THIS GREAT SERVICE THAN OTHERS), PLEASE HAVE THEM CALL OR EMAIL KELLEY BROWN LINDSTROM AT (619) 656-5251 (KELLEY@OBESITYLAW.COM) HERE AT OUR OFFICE FOR MORE INFORMATION.

2. Once they get the Application, follow the instructions on that packet. They can help you fill it out (it really is quite easy) and then either you or the surgeon's office FAXES us the application and the supporting materials we need. That all needs to be done within 2 weeks of the application being received by the surgeon's office so we are sure that there's ample time to appeal on your behalf.

3. The faxed information comes to us electronically (no paper is used/no trees destroyed!). We review the information and notify you and the surgeon's office that you have been accepted into the program or if we cannot take the case, we'll let you know why. From the looks of what you gave us in the online form you just sent I see no reason we cannot accept it. If, for whatever reason you may not be accepted into the appeals program or this type of denial does not qualify for that program, we can then discuss whether you should hire us directly.

I'm confident we may be able to help.

[kismifac 0]

Hi. Have you considered talking to a surgeon to negotiate payment arrangements? My surgeon was very flexable that way and from what I understand a lot of patients struggle with getting insurance to pay for the procedure.

[aimlagana 0]

Hi tcbeau. Walter sounds like he can be a great resource but I thought that I would offer my two cents. Co-morbidities can be broad. Think about your joints? Does your back or knees ache? This is a co-morbidity. Have you sugars and blood pressure checked. Borderline diabetes and hypertension are common co-morbidities in overweight individuals. sleep apnea is also another one. Do you snore? If so, it's probably worth a sleep study. I would also find out what you BMI needs to be (usually 40) for the Insurance company not to require co-morbidities.

Best of luck,

Aimee

[MacMadame 81]

Co-morbidities may be broad but some insurance companies are picky about the ones they count. UHC, in particular, has a specific list of the sort they consider. It has to be things like Type 2 Diabetes, Hypertension and/or high cholesterol you are taking medicine for or something like that. Joint pain, urinary stress incontenence and things like that aren't considered by them.

They have their bariatric surgery policy on their web site. You can check it out and see exactly what they say about their requirements.

OTOH, I thought they had 30 days to tell you why you were denied. It's been longer than that so you may be able to get them on a technicality!

[tcbeau 0]

walter, thank you very much for the information. Are you referring to the online form I filled out on obesitylaw.com? Should I wait for the second denial letter from UHC or is the verbal denial by phone enough information to start this process.

[Who'sThere 331]

I am very sorry to hear about you denial from UH. I also have UH and will be going through this process soon myself.

However, I would be surprised if PCOS was considered a co-morbidity. Many PCOS patients are obese, but PCOS is not caused by obesity. There are folks with PCOS that are not overweight.

Since you do have PCOS you are at a higher risk for many co-morbidities that go along with obesity. High blood pressure, diabetes, or insulin resistance (kinda like Pre-diabetes) are just a couple. As others have suggested, I would look into ANYTHING that might be considered a co-morbid condition.

Good luck!

[tcbeau 0]

I hope all goes well for you, I have high cholesterol and am on meds for that my BMI is also 39. I hope you get approved fast, after my second denial I think I will turn to obesity law for help.