Insurance says they cover for "morbid" obesity but i cant find it in my policy!!

[shortgal 5]

Your surgeon will help you submit all the paperwork.

[Melisa1 0]

Thank you ....im trying. Do you think the fact that ive asked them that direct question several times on the phone and documented dates i have a chance or could that be stated somewhere where i havent read? Someone told me they have to state that in your policy if thats the case?? Do you know?

[shortgal 5]

I have UHC choice plus, but I was unable to provide the five year history ( I had some weights to show but they had gaps) and I was denied. Maybe they've changed the requirements or it varies by employer????

[Melisa1 0]

so did you end up just paying out of you pocket? What about them telling me over the phone that i dont have to have that? I specificly asked them that question and they have told me no.? The lady in the office said to document it becuase she has known of cases overturned because of documentation. I just cant believe that they wouldnt state that in the policy if that were the case?? Do you know if that was stated anywhere in your policy?

[Melisa1 0]

yeah my husband is trying to calm me down right now. He is telling me that it might vary by employer too. I just dont understand why when i call them they are telling me no that all i have to have is a letter of pre determination and then im hearing this 5 year bmi stuff. makes me crazy! lol all i can do is hope for the best at this point. makes me exhausted thinking about it.

[Bea1128 1]

I have UHC choice plus as well. I had to have a 5 year history. I had both my regular doc and my ob-gyn give me all the progress notes they had, but I could only account for a 4 year period. I had those records ready to go before I even met with the insurance specialist at the surgeon's office. My weight has fluctuated as well and there was a time about 3-4 years ago that I was under the 35-40 bmi rule. I do not have any comorbidities and I was approved in less than a week. I can't say it will be the same for you as insurance varies case by case, by state, and by employer. You'll have to request records from your other docs and I suggest you get those as soon as possible even if your insurance says they don't need them. Having too much info is better than not having enough. Pick your surgeon, if you haven't already, and let his office deal with the insurance. You're not going to know what your insurance company will do until you try it. Good luck.

[shortgal 5]

I did pay out of pocket. I was denied and appealed and was denied again.

My policy had little to no info. You just have to submit and they will have one of their Dr reviewers look at the papers then and see what happens, some ins companies are better than others. I think UHC sucks!

[Melisa1 0]

Thank you guys!!! I really appreciate all the info. I think what is going to help alot is the letter from my pcp. He stated all my problems associated with being morbidly obese and how he recommends this surgery for me. I dont know if i have a chance but i will fight to the end if i have to. especially since they said on the phone twice that i dont have to have that five year history!!!

[Melisa1 0]

shortgal what state are you from? not that it matters i was just wondering