Has this happened to anyone else?

[southernbelle13 0]

Hi all, I am trying to get approval for lapband. I am 35 with a BMI of 37. I have sleep apnea, GERD and arthritis. I got a denial from UHC and just found out today they sent in the paperwork without my letter from my PC and without my sleep study. I am looking for someone who got approved with UHC with stats like mine. I am really discouraged because I really want this surgery, I need to get healthy. If anyone has any helpful advice I would appreciate it, I am worried that I am going to have to do an appeal. Thank you.

[SuzanneG 1]

Sounds like the first step would be to call and tell them that some information was missing from your package. sleep apnea, I'm pretty sure would get you approved under most insurances.

I was denied throught BC/BS and ended up having to appeal. I wrote 2 letters of my own, plus asked each of my docs for letters of support. I've shared my letters with many folks on here and would be happy to send them to you if you end up having to appeal. You are wlecome to use them as a template.

If you want the letters, just PM me with your email address and I'll send them to you.

Best of luck to you.

[southernbelle13 0]

Thank you Suzanne, I got a call from my doctors office today and they have resubmitted the claim for auth. So we will see what they say in the next week. I would love to have copies of those letters though, I want to be proactive in getting my ducks in a row if the deny again. Thanks again.

[dolphinz 0]

I was approved thru UHC. I had a BMI over 40 though so I didn't need any comorbidities. However, they did say if my BMI was between 35-40 than I had to have TWO comorbidities (i.e. sleep apnea, congestive heart failure, COPD, etc.) I did, however, specifically ask about GERD (as I have that too) and they said that did not count.

I'm not telling you this to get discouraged, just so you can be prepared. Each employer's plan is different even with the same insurance company so maybe you will only have to have the 1, and with the sleep apnea that's definitely 1.

Just thought I'd let you know the info I have!

[southernbelle13 0]

thanks for the info..hopefully it will go through, otherwise I guess I will be writing letters of appeal

[SuzanneG 1]

Keep me posted on your progress!

[katwmn63 0]

ifyour arthritis is severe enough, that should count as another co-morbidity.