United Healthcare Denial?

[Melisa1 0]

thank you soo much. every little bit of help makes a big difference. :tt1:

[salome000 0]

Hi! I'm new to the site and was wondering if anyone has dealt with United Healthcare (Caterpillar)? I've been to see the surgeon and after talking with the adminstration was told that in order for United Healthcare to pay, I would have to have five years of documentation along with a BMI of 40. So, I'm guessing, I'm already going to be denied, since my BMI has never been 40. Has anyone ever been denied because their BMI was 39 and not 40? Thank you!:confused2:

I have UH and a 36.1 BMI and I just got my approval. Here's the deal with the 5 year documentation. Just take your old pics with dates on them and that satisfies the requirement of showing you've been overweight all your life. UH shot back a quick approval because I had sleep apnea, which is considered a co-morbidity. Do you have a co-morbidity? If so, you're in. If not, they won't approve it at all.

[acadiamom 0]

Salome is very lucky!!! It seems every UHC reviewer is different. My expedited appeal went in today....send good thoughts my way, OK? If all had gone as planned, I would have been 8 days post-band right now . I'll keep you all posted on how it goes. It would seem the letter from the PCP was the key piece of information they wanted (my UHC coordinator said no to pictures, "the guidelines are very specific"). We'll see...it's a waiting game now....

[salome000 0]

acadiamom...I was so surprised that your reviewer wouldn't take pics!!! It would seem all UHC policies would be the same and I'm sorry they wouldn't take yours. My 'quick approval' was actually a year in the making. I got denied at first because I didn't have documentation of sleep apnea. It takes freaking forever to get all the appointments in, doesn't it? Make sure to call the number on the back of your card and check the status...I knew I had an approval three days before the letter.

Good luck to you!!!!!

[KingsFan 0]

I got the denial of my last appeal from UHC. My company's plan specifically limits WLS to those who have a BMI of 40 or over and have had that BMI for at least five years. I had a BMI of 36 but have diabetes, HBP, and metabolic syndrome as co-morbidities. The denial letter said that UHC had no discretion to alter the plan's specific provisions. I was lucky enought to be abe to self pay and I was banded on Sept. 12. If any of you get approved despite specific plan provisions, I would love to hear about it because I am considering a lawsuit and would love to have evidence that UHC did have discretion to cover me. Good luck to all and I can tell you, even though I am only 7 days post-op, that it's worth fighting for.

[rulooknatme 0]

I was approved! My BMI is 41 right now and was as low as 38 in the past five years. I was just diagnosed with sleep apnea recently. I also have asthma. I am not sure what aspects of my health played part in my approval but I was approved! I hope that your appeal gets you approved too! Good luck!:biggrin:

[Cayden'sMa 0]

CaydensMa~did you get approval yet. Im hoping i get approved, however my bmi is 40 and i have no comorbidities :rolleyes2: 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?

:frown:Melisa1, sorry for the delay in response. I just received my denial today. Now I don't know what to do. I was told that my bmi hasn't been 40 or over for 5 years. I'm sooo upset. 5 years ago, my bmi was 36. I do have high blood pressure however, and COPD. I believe the letter from my doctor also listed joint disease. Probably what scares me the most is my mom passed from complications of diabetes, and all 3 of my brothers have diabetes. Although, I don't have it yet, my blood sugar levels are slowly creeping up. It seems if I lose a pound, I gain 5. Hope you have better luck!

[ssflbelle 829]

Well I also have United Health Care but it is through the Medicare advantage plan as I am disabled with numerous physical problems in addition to a BMI over 50+ I was denied and not only that they will not even pay for all the testing I had done. Before I even saw the WLS the consultant told me all I had to pay was $500.00. BS!!!!!!!!!!!! UHC stinks!~ I will be appealing, this is unbelievable that I would be denied with all the complications I have.

[shelly0320 0]

my health ins switches to uhc in jan- will i have to wait some kind of waiting period before they approve me ? i was already denied once by cigna for no 6 mth diet, but i dont think with uhc there is a 6 mth rule.

[Chris61 0]

I would not think that you would have to wait on anything. I would call in January and make sure it is in the plan and ask what they will need. I had UHC Pro and had no problems in getting approved. I have had UHC for 4 years. The first 2 they did not cover the band and then all of the sudden it changed. I have heard other have had problems. If you send me your e-mail I will forward a letter that I and the wife used to help get us approved.

Chris

[shelly0320 0]

Wow - thanks chris- that would be great to see the letter- hey i see your in florisant? was your surgery at depaul? that is where mine will be if i can get it approved.

my email address is

lilmc0320@yahoo.com

[2brn 0]

Did you have to be Morbidly Obese for 5 years in your records? I have been obese for 5 years but only morbidly obese for about 2.

Thanks

Edited October 24, 2008 by 2brn

[shangefan 193]

I have United Health Choice Plus. My policy has an exclusion for WLS. I think that is asinine, given the cost of caring for co-morbidities. But it is their decision (based, of course, on the plan that my employer chose). I am going to be self-pay.

[2brn 0]

Where you morbidly obese for 5 years, cause that is my thing, I have a BMI of 43 right now, but my five year weight history I was just obese. So I am wondering If I will get approved.

Thanks,

2BRN

[acadiamom 0]

Well, persistance has paid off! After my corporate advocate "clarified the intent of the corporate plan" with the appeals manager at UHC, they re-reviewed everything and I was approved last week (I only just heard on Monday). My surgery is now scheduled for November 19th! Upon appeal, I had supplied a letter from my PCP (that I actually drafted for them) as well as some additional weight loss program information. It never should have been denied in the first place, though.....for those of you who are still fighting, keep going! I saw an earlier post that said the WLS was restricted to BMI over 40....I'd double check your plan since that is not in alignment with NIH guidelines. UHC tried to deny me the first time saying my plan stated only aboe 40 BMI, but they were wrong.....I reviewed a copy of our corporate plan and it included provisions for BMI over 35 with co-morbidities.