Denied. Again.

I heard back from United HealthCare on my appeal. I was denied again, this time with the explanation that I had not achieved the 10% weight loss required prior to authorization. These people are incompetent!!! It's bad enough that they didn't handle my appeal within the time limit specified by the contract, but they apparently didn't bother to read my letter or look at all the documentation either. I was referred for surgery on October 13, 2004 by my primary care physician. My weight at that visit was 284; records of that visit were provided with my appeal. Between that visit and my first visit for the 6 month physician monitored program on October 27, 2004 I lost 7 pounds, so my first weight there was 277 - which is the starting weight cited in the denial. On April 19, 2005, I weighed 254. My appeal letter detailed the starting and ending weights, so I don't see how they missed the correct starting weight. Even so, we're talking 4 to 5 pounds if they use the later weight - and that's grounds for denial?? The person from UHC that called me is going to contact the reviewer to make sure that the PCP's office record was reviewed and if it was, try to get an explanation of why it was not considered. She said that she might not be able to get this explanation today - so now I will be waiting longer. I've already waited three weeks for an appeal that should have taken no more than two (per the contract), and I am still denied. I do not see any reason why my PCP's office record would not be acceptable. This is just ridiculous. I have sent an email to our UHC rep and to our HR department that tells them what I've said here in a slightly nicer way, but I'm starting to think about hiring a lawyer. I would just lose the 5 damn pounds they want, but I'm afraid I've probably gained some of what I lost back since I stopped the diet and diet pills. The pills aggravated my acid reflux and made me really *****y, but I guess if I have to I'll take them again...

Hang in there! I was also denied because they said I didn't meet my 6 month weight loss goal... however after I flipped out and probably caused my blood pressure to go through the roof, I found out that one month was left out when it was sent. Don't give up!!! I had my surgery on May 9th and it made the two years I spent trying to get approved well worth it!

Thanks for the encouragement. At the moment I am more mad than anything else about this. The incompetence of the insurance company really ticks me off. I'm trying not to let this get me down but it's really disappointing. Phooey on UHC! I really admire people like you who have persevered through years of denials! I am so glad to hear you finally made it and had your surgery.

Gabrielle, I am sorry that you were denied again, don't give up. Our thoughts and prayers are with you. Jennifer

Thanks for your support! I'm not going to give up, but this is really disappointing.

sorry to hear you where denied. I fought them for 2 yrs. keep fighting, don't give up. it will happen. I know how you feel and some days it was hard and I cried. In the end it happened, so take a breath and go for it.

Two years... wow. I guess I've already been doing this for about 7 months, but jeez... I'm working on my game plan and trying to consider all my options.

It took me 15 mos to get the approval. And you are right they don't read. They make the rules and then they don't bother reading everything. It took me going to the PCP office and having a conference call w/ my PCP and Cigna review board. When the lady called to say I was approved she said they did not know of a piece of the puzzle and I should have been approved prior. I made copies of all my medical info myself and sent it 2 times! It cost me $42.00 I had so much to copy. So just keep fighting! Good Luck! Wendy