United health care 5 year weight history.

[jr64044 0]

We may have different plans but I was told by my surgeon up front my insurance company (UHC) requires you to stay overnight. I was banded July 20th,( 2 1/2 weeks ago) and my surgeon kept apologizing to me that day that I was not able to be discharged. My surgery was scheduled for an hour to an hr and 45 min. My surgery was done in 20 min because "everything was text book perfect" So I don't believe I was facing any complications. UHC is refusing to pay my surgeon on five cases because the patients were let go that day.

All I am suggesting is that if you have UHC, you will want to double check all of those things, so you are not thrown with a surprise at the end of all of this. This should after all be a great experience, not a stressfull one.

[Aurelia 2]

I have UHC choice plus and my surgery is done and paid for.

[yzplnxg 0]

Still waiting..

Ive been on vacation.. sorry for the delay in answering. I'm still waiting. It will be two weeks this Tuesday. I've called several times and UHC says everything is pending.. One of the reps said they had ten days but the last one I spoke with said they have thirty days.. who knows.. I guess they are going to take all thirty days...

[Becky Lou 0]

yzplnxg,

Any luck yet, I have UHC Choice as well and have been waiting since July 26th. I'm so nervous. My BMI is 36 and I have HTN, back pain, knee pain, ect. the plan calls for a BMI of 40 but they did tell me it was going up for review but has not been denied. I have a strong family history of Diabetes, HTN, High Cholestol ect. so I'm hoping that will help. Please keep us posted

I will keep my fingers crossed for you.

Good Luck!!

yzplnxg yzplnxg

[yzplnxg 0]

Becky Lou,

I haven't heard anything yet. My insurance required five years 40 BMI (like yours) or higher OR doctor statement saying surgery is a medical necessity. I thought the doctors letter was sent in on the original request because I thought everyone understood what the ins required and what my BMI's were. We did discuss this.

But... The letter was not sent in UNTIL the insurance denied the surgery and then the ins clerk sent it in as an appeal so she waisted one of my appeals. I feel like the doctors office let me down on this one. The ins company said it would take between 15 to 30 days for a ruling on the appeal. This is day three. I am hoping so much that it doesn't take even 15 days. This is torture!!!

Please keep me informed as well. Sounds like you and I are in the same boat...

I have High Blood Pressure on meds runs about 158/84. GERD. Really bad joint pain that I will have to do something about if I don't loose weight. I have sleep disturbances. weak bladder. Really bad Asthma. Shortness of breath. depression. I also wrote my own letter to the insurance company outlining why I thought the surgery was medically necessary and letting them know of the diabetics that run in my family and how my dad died at age 59 of congestive heart failure and the illnesses and surgeries that my Mom is having. I explained how spending the money on this surgery would save money on joint replacements. I don't know if this will help or not but I wanted them to see that I am a real person not just a file and that this will improve my quality of life.

[Becky Lou 0]

well I just got off the phone with UHC DENIED!! I'm so upset. I'm going to call the Dr. Office and see if they can do a Peer to Peer conference call. Reason for denial is low BMI must have a 40 I'm at 36.6.

[yzplnxg 0]

You can appeal I have read a lot about appealing. I sent you my email. I would like to talk with you. Also. What is HTN. ???

[yzplnxg 0]

Becky Lou,

How is the fight going? Are you getting anywhere?

[PrincessErin 64]

Jem,

You've seriously given me hope, too! I'm so nervous that I won't be approved. I think because I want it SO badly, that I'm pinning a lot of hopes and dreams on it.

Anyway, I have UHC Choice Plus, too. The procedure is definitely covered but my last 5-7 years of medical history/weights are definitely spotty and span over about 4 different doctors. I wasn't morbidly obese for the entire time, either. I've tried SO many times to lose weight and some of those times have been successful - for a few months.

Anyway, my BMI has definitely been over 40 (like 41) at different times throughout the years and it's definitely been as low as 32.2 (but I was exercising 10 hours a week and practically starving myself and I gained it all back plus some).

I'm scared that UHC will say NO because I have not had a BMI of 40 for 5 years, so I'm hoping I get the same experience as you!!

Did UHC require the 6 month supervised diet before surgery? If so, do you get disqualified if you lose weight and go under the 40 BMI?

[Jerseydiva15 3]

I have UHC Choice Plus, my surgery was approved. They requested 5 year history of obesity. I have been with my current doctor for 2 years and I called previous doctor's office and they didn't have my chart anymore. My primary doctor was the one that submitted letter. Now I don't have any medical problems now but my pressuse has been goingf up recently and back pains. So it was more approved to avoid future health problems that could be cause by obesity. Right now I am considered morbidly obese.

They did not require 6 month diet before surgery.

[jem8384 0]

Bubbles77 im glad I can give you some insight. I was approved they didnt give me any problems with the scattered medical history or the BMI of 40 for 5 years it was great I really didnt have a problem with UHC. Now, what my doctors office did tell me is that UHC rarely gives them issues which is a good thing they said they love working with them. I my surgerversy is coming up and im down 90 pounds Good luck too you!

[agiudice 0]

i have UHC as well. I was originally denied after waiting the full 30 days. The dr office appeal and i was approved in days. Bizarre but i'm well and banded now....dont give up!

[Revolver 1]

i have uhc as well. My Dr's office said the 5 year history was mandatory but they said all they needed was my medical records with my weight recorded for every Dr visit. I am doing the 6 month waiting and diet period so my Dr will be submitting my claim in January.