United Healthcare Denial?

[Olivia23 68]

Hi. I am new to posting on this site, but not browsing LOL! Anyway, I also have UHC, and I checked online to see that my insurance does allow gastric bypass surgery so I'm assuming that they allow the lap band. Anyway, like others, mine says I have to have a BMI of 40, but I only have a BMI of 37. I know I am getting on up in there into high cholesterol and I believe I have some form of sleap apnea. I have not been to the doctor in over a year, but the doctor I used to go to was trying to help me lose weight with pills. I did loose about 30 lbs. but gained it all back. I don't think it's been 5 years since I had been seeing that dr. but it would be close.

I am wondering if there is any chance I could be approved or should I not waste my time. I know I will probably try anyway, I just hate to be shot down. I want to stop the weight gain before I get too big. I know I'm big now, but I also know it can get a lot worse.

Edited September 13, 2009 by Olivia23
More to add

[tYME4NEWBEGINNINGS 0]

Hello everyone,

I have so many questions and concerns i almost dont know where to start..well let me just say obesity definatly runs in my family..Im coming from an household where both my family decided to use wls as a tool....but anyow im 5'4..310 ibs dealing with asthma, and high cholestrol...i have empire (blue cross clue shield)..united healthcare insurace....im wondering will i get approved is there certain measures that i need to take to increase my approval rate..?? well i guess thats all for now

thank you

[ParrotheadCathy 0]

Tyme....with a BMI well over 40 you should not have any problem getting approved. EVerybody else, it seems like a lot of insurance won't approve unless you have a BMI of 40 and no comorbidities, but a lower BMI if you have at least two of the accepted comorbidities (Type II Diabetes, sleep apnea, high blood pressure are the ones I know of). But some require that you have a certain level BMI or higher for a specific period of time (for example, my friend had to have a BMI of 37 for at least two years).

I always tell people to CALL THE INSURANCE COMPANY and find out exactly what the requirements are on your policy so that you have a better understanding of the whats and whys of the approval process.

If you are told your policy has a "written exclusion" for weight loss surgery or weight loss treatments, you're out of luck. You cannot even appeal that to the insurance commissioner in your state. In that situation you really have no choice except for no surgery or pay for it yourself.

[photographer 0]

Hey,

I am currently VERY close to a BMI of over 40, I live in Ohio and my husband has UHC, so I am just wondering what they want for approval, I know every plan is different. Do I have to be over weight for the past 5 years, is that all? Thanks, just curious?

update- as far as I know what I have to do is have a BMI over 40 and go on a 6 month diet and I was told that at the end of that diet I must still be over a 40 BMI or surgery won't be covered, so any suggestions on how to keep the surgery being covered? Cause I don't want to loose 10 lbs after going on a diet and then not qualify for the surgery being covered...???

Edited October 16, 2009 by photographer
update

[susan0978 0]

I have UHC and had my surgery last month. I was approved right away. My BMI was 40, but I have high bp and diabetes. I also have a history with my PCP of over 5 years of obesity. My doctors office told me that I would have to do the 6 month weight management program but I called the insurance company and was told my policy did not require that. I think it depends on the terms of your policy not just the insurance company.

[BeefromCalie 0]

I have UHC and they paid for my surgery. No six month weight. BMI 42 I did have over 5 yrs weight history, I do have high bp and boderline diabetic (not on any diabetic meds ). When the requested was submitted I was approved in less than 2 weeks.

[sweetred1967 0]

I am posting just to say thanks to this forum and this thread, I finally got my surgeons office to submit my paperwork to UHC today.

My UHC policy requires BMI over 40 and 5 year history of BMI over 35. I am 5’ 4”, 240lb’s with a BMI of 41 and several co morbidities. My BMI was not over 35 in 2 of the past 5 years, although there had been various times during the past 10 years when it had been.

My surgeons office felt I would not be approved if I submitted my 5 year history as is. However by following the advice of this thread (and a brilliant example letter form Chris61 - Thanks Chris), I finally got 10 years of history from my PCP/OBGYN and drew up a personal letter to be included with my submission.

My Patient Coordinator thought the letter would go a long way in getting me approved.

Now I will wait and Pray......

Thank you all.

Edited November 3, 2009 by sweetred1967

[Ronda68 2]

I have United and my policy does not cover lapband or any form of weight loss. Guess I need to keep trying to get this weight off. :thumbup:

[Chris61 0]

Glad to help you out Sweetred1967, I hope that it works for you with all the information they are loooking for. It is amazing how much we have if we just take the time and try to find it all.

Ronda 68 Take a lookat your policy after the first of the year. I happen to read my policy several years ago and found they did not cover it and then happen to do some checking on the policy and found that it had been changed and the rest is history.

Chris

[Ronda68 2]

Thanks Chris, I will keep working on it. I did call my insurance company and gave them just the code where as before, I asked if they covered the Lapband. He didn't tell me no...he transfered me to someone else and she said she can't tell me yes or no because I have to meet the requirements. To me, sounds like they will cover it if I meet the requirements. She also said to have the Dr. call. Right now, I am just waiting on a call from the Dr. telling me yay or nay, it's been since Saturday that I gave my Dr. my insurance information, I am crossing all that can be crossed! I do have sleep apnea, acid reflux, leg pain/swelling. If I am correct 2 of those are comorbities (sp?) so I might stand a chance but not going to get my hopes up...although it's kinda too late! haha!:biggrin:

[HapiCat 0]

Ronda -

I am too waiting for an approval from UHC (Medicare replacement) I got the yes we cover it on the procedure now theyt are sending in the paperwork on me as the actual patient.

Fingers crossed for you!!!

[Ronda68 2]

I am going with Dr. Malley at New Hope and when I went there for my seminar on Saturday the 7th, I gave them my insurance info and was supposed to schedule an appointment but didn't because of what my insurance said the week before. But Dr.Malleys office is checking on it anyway and said to make an appointment and if you are approved they will not call but if you aren't approved, they will call you so I had no way of knowing if I was approved so I called them today and said screw it and scheduled my appointment in hopes that I don't see "Dr. Malley" on my caller I.D. So my appointment is set for November 18th unless I get a call from them so wish me luck!

[Paigey 7]

For those of us with UHC, it's not always a bad company to deal with. So far, I've had a very good experience with them.

I have United Health Care and a bmi of 36 to 37 with a couple of co-morbities(sp?).

I went to my seminar 9/19, saw my primary care physician on 10/3, asked for and received the referral for lapband surgery that day.

Within a week, he had most of my pre op tests scheduled and my surgeon's office called to tell me that my insurance was approved to pay 90% with no deductible.

I am certain that if I wanted to go ahead and push through all of my appointments quickly, I could have the surgery within a few weeks. I'm too chicken to do that though.

I know this will be the last year I am able to enjoy Thanksgiving and Christmas food, so I am waiting until the first of the year.

[Ronda68 2]

Did you have to have 5 years of doctors records that you were overweight? If so, I may have a problem, I've been pretty healthy the past 41 years (other than being obese)and until recently haven't been to the doctor all that much therefore, don't think I can come up with 5 years in a row of my weight being what it is today. Might be able to come up with a doctors visit once a year...does that count? lol

[Chris61 0]

If you have just one Apt. for the year that should be fine. Also you can pull all of your doctors stuff together and do it in one letter. Ie; OBGYN, Orthopedic, GP, Others that took your weight when you went to see them. I hope that this helps you out. If you would like to see the letter e-mail here and I will forward it to you. The more co items you come up with helps as well.

Chris