I could just cry, UHC who makes the decision??

[Becky Lou 0]

I have UHC with the requirement of a BMI of 40 with a 5 year History.

I went to my consult about to weeks ago and have a BMI of 36 with HTN, Back pain and High cholestrol.

So I called UHC today and the Customer service person said they received the letter of medical necessity from the Dr and that it is in pre determination.

He told me it looks like I don't meet the requirements because it states you have to have ALL the requirements and myBMI is only 36.

Is it up to him?? Does he really know?

I'm so dissappointed I could just cry.

[Jodi_620 37]

Not necessarily. Sometimes the customer service people are not clear on everything (sometimes they are not clear on anything!) You should have asked for details of coverage in writing. It is possible that with the co-morbidities they may allow 35-40 BMI, a lot of insurance policies do. Then again, it is possible that they do not allow for co-morbidities. Either way, you should get the information in writing so that you are armed with the facts.

[ashleysara 0]

I would try anyways my insurance company says that they accept 35+ if you have a comorbity like yours. I have cigna though but good luck

[Chris61 0]

I have UHC and was right on the boder of 39-40 and was approved. Did you give them all the information like fives years of weight, number of diets and how you did? Medical history showing what you have had over five years, and then what about family problems? Also did you make a list of issues that you might have such as hypertension pre, pre diabetic, back and knee problems, what is the doctor putting into the letter? Also you could put a letter in the doctors packet that he sends in expalining why you are wishing to have this. Also did your primary car doctor support you with this? My wife had that problem but we went to her OBGYN and he did the exact same letter and she was approved in no time. Once the stuff is submitted it will take about 30 days to get approval? I would ask the doctor how they send the letters in to UHC. They may fax it or send it by snail mail. Good luck with things. If you would like to see the letter that I used and was approved with I can e-mail it to you so that you have an idea of what should be in there.

Chris

[KeithW 0]

In the UK, NICE (National Institute of Clinical Excellence) guidelines say that you need to have a BMI of 40+ or a BMI of 35+ with ailments that are likely to improve with weightloss surgery, (such as diabetes.)

[Jodi_620 37]

It may not take 30 days to get approved. I have UHC and was approved in less than a week. A third party did the approval and the approval letter came from them with an approval code.