United Healthcare Denial?

[goin2lasvegas 0]

I have to do the 6 month requirement and it is a joke! I have been seeing my doctor for 3 and half months and we both know I need the surgery and my doctor gave me his blessing and a hug! I am ready and I just look at it as a bump in the road, but it won't deter the trip!

[acadiamom 0]

Well, I have another update and hope this helps others who are dealing with UHC. My surgeon had a teleconference with the UHC medical director who denied the claim. Despite faxing additional records, they would not overturn their decision. It turns out what they want specifically is a letter from my PCP with 5 years of weights and a statement of co-morbidities. I read through some of the posts here and used a sample letter as a starting point. I ended up writing the letter for my PCP to review and edit. I work in medical research with a number of physicians, so also had the benefit of having one of them read and edit my letter before it was finalized. As it turned out, my PCP decided he liked it as is, so will be faxing that in as part of my appeal process. I would suggest to those who have not submitted their package yet to plan on including such a letter in the first go-round. Maybe this will help smooth the approval process. I'll keep you all posted on the final outcome....for now, my surgery has been cancelled until this is straightened out. A real bummer.....

[alteration 0]

I also have uhc choice plus, i am so nervous to hear the outcome. The surgeons office submitted my paperwork about 8 days ago. Im really nervous about calling them to inquire. I want to wait till i get the letter from uhc so i will know if i have to cry or rejoice!

[acadiamom 0]

The thing was, UHC never even notified the surgeon. We were 4 business days before my surgery and the office had not heard anything. They found out about the denial when they called for a status report on the submission. The plan now is to submit the request for an expedited appeal. The surgeon's office is still waiting on some forms that UHC was supposed to have sent them for this purpose. I'll keep you posted. In the meantime, it may help to call UHC and see what the status is of your paperwork...good luck!

[Melisa1 0]

Hi guys...i dont know if im in the right place to ask this question but...I have UHC ppo. They cover 90% for bariatric surgery. Ive done all my testing. sleep study, ekg, blood, urin, chest xray and endoscopy. Then "today" my surgeons office tells me that i have to have a five year history of having a bmi over 40 or two co morbidities. First of all...why didnt they tell me this at the beginning? and second is this stated in my policy? they flat out told me all of a sudden that it wont be approved by my insurance? This is such a slap in the face. Ive been over weight all my life, my bmi is 40 and i weigh 230 lbs. 5'3". Yes my weight has dropped 5-10 lbs up and down forever but COME ON. thats rediculous! Does anyone have any recommendations or ideas, answers, hope??

__________________

Melisa:thumbup:

[acadiamom 0]

Hi Melisa! I'm in that same boat, except my paperwork was already submitted. You have a great opportunity to get this together now and not go through a denial! Try to contact your primary care physician and see if they will supply a letter. That is what UHC said I needed and we're using that for my appeal. Let me know if you want a sample letter....email me and I can send it to you. WHile I don't know yet if this will do the trick, my surgeon's office thought the letter was excellent and should be what was needed.

[Melisa1 0]

yes...omg i would love to have a copy of the letter to help me in any way possible. My e-mail address is melisa1@verizon.net. Thank you soooo much! I appreciate that!

[Cheryl Ann 2]

Just wondering if you've heard anything yet.

My own UHC experience was great. However, as it has been pointed out, not every plan is the same. My husband's plan, which was specific to his company, had no exclusions, no need for five years' documentation, and I was approved on the first try -- and my BMI was 38.3, plus documented morbidities.

It's a good thing I was approved on the first try, because I found out on a Friday, and my surgery was scheduled for that upcoming Monday!

[Melisa1 0]

WOW THATS WONDERFUL. I sure hope i have the same luck. Im 230 lbs, 5'3". My bmi is at 40.1. I have gerd but ive heard different things about it being a co morbidity.? Do you know if bladder problems are considered a co morbidity? I also have had back problems for years which is documented in my history. But i have no high bp, no diabetes, and no sleep apnea. ?:sad:

[Cheryl Ann 2]

I'm not sure if bladder problems are considered a co-morbidity (unless you count the chance of dying from embarrassment!), but I would imagine that is one more thing to document. It certainly couldn't hurt, and I believe that stress incontinence was, in fact, one of the more "minor" things listed on my submission papers.

I guess my major co-morbidities were my high blood pressure, and to a lesser extent, my sleep apnea (which was mild to moderate). Besides the stress incontinence, they also noted joint issues, but also my hiatal hernia (a major source of GERD for some). The hiatal hernia was repaired during my Lap band surgery, and was a separate charge, but also covered 100% (as was the Lap band surgery) by my plan. The only cost incurred was a $35 hospitalization co-payment.

I was very lucky. I could not have afforded to self-pay, so this was the equivalent of hitting the lottery, IMO!

[Melisa1 0]

acadiamom~please please let me know how it turns out for you...im dealing with UHC too and getting ready to submitt my stuff. Could i get an example letter from you if possible?

[Melisa1 0]

CaydensMa~did you get approval yet. Im hoping i get approved, however my bmi is 40 and i have no comorbidities i have now idea if they will approve me. I have UHC preferred plus. Throughout my five year history it has fluctuated under 40bmi so i dont know?

[Melisa1 0]

Does anyone have a sample letter i could look at for insurance? I have one but id like to look at others out there that helped with approval. Thank You very much! melisa1@verizon.net

[Cheryl Ann 2]

I don't have a sample, since it was submitted through my surgeon's office. However, my chart notes all those co-morbidities and weight-related conditions, so I am pretty sure that information went into the letter and forms submitted on my behalf.

[acadiamom 0]

Hi Melisa--I sent the sample to your email address....I'm too new to this site to know how to post attachments!