Rejected

Hi all.  Not a very good day, as I called insurance and found out I didn't qualify for my surgery, even though I met all their criteria. I have to wait for their letter to have the doctor's office send in an appeal. I can't get any more blue. Anyone else have the same problem with United Healthcare choice plus? I just want to cry. Allison

Allison, so sorry for you. Why did the insurance disqualify you? They should give you a reason. There are lots on this board who were rejected at first. Hang in there. Hugs, Lisa

Allison, what did they say it was that you did not qualify with? The reason I am asking is that my sister also had UHC (unsure about the choice plus part) and she was denied with one policy that she had because she did not have 5 years of MO behind her. She appealed twice and was still denied. She then was employed full time with a company that had basically the same police with UHC and was able to have her surgery.  Keep the hope up that you can still have surgery via an appeal. Christine

Hi Allison: Chin up.....lots of us were denied on the first (and subsequent) tries.  Once you know their reasoning, you can attack that in your appeal.  Many times, they just send out a denial hoping that you will accept it and go away.  I have heard of many insurance denials that were for something "missing" that they already have if they take the time to LOOK at the records that you sent them.  Hopefully, it is something minor like that and you will be back on track in no time. It took me almost 2 years and 2 different insurance companies before I was approved.  Keep up the good fight and you will eventually win.

Hi Allison, Just wanted to offer you support.  Hang in there! Hugs, Paula

Thanks ladies for all your support. When I asked the guy over the phone, he said I wasn't excessively obese and that is why the denied it. My surgeon and I both went over their criteria, and I met it with the proof of 5 years + obesity and 2 co-morbids, the whole thing. My BMI was  39.1 instead of 40 BMI.  What is 5 pounds?  I still haven't gotten the letter in the mail, but when I do, the surgeon is gonna definitely fight their decision. I hope I am not stuck with this body and health for the rest of my life. Allison 

ALLISON - IN A WORD - APPEAL. CHRIS

Sorry about the reject Allison.  It took me 18 months, 3 appeals and letters to 2, 5, 7 and Oprah to finally get approved.  I had plenty of co-morbids, the 5 yr. history and the high BMI, but Blue Cross just kept diddliing me hoping I would give up.  Appeal-nag-have your surgeon get involved-don't give up-look at Kim-she just got her miracle-you will too.  Big hugs-Janet K

Allison,      Ok I know this sounds like bad advise, but gain the stupid 5 pounds.  Right now you are depressed and it will be easy for ya to go and start to ear, I say do it.  I heard a lot of people doing that and they got approved on the next try.  It will come off and a lot more will come with it.  Keep fighting the good fight, but take the one bullet they had and remove it.  So you don't hit the 40 BMI, hit it.  You will lose it afterwards.      Again I know it sounds like backwards logic, but when I initially was going for my band, I talked with people who worked for UHC, off the record, and they said I would have been denied.  So I went forward and made sure I hit all criteria.  I got approved the first official try.  If the BMI is all they are saying you don't meet, then go ahead and hit it.      Yep guy logic, but it worked for me.  Good luck Allison, you will get your surgery!  I know it!

Allison, Your story was my story!  My BMI was 39.8.  yep I was denied 4 times.  Pam and I have come up with a great way around this.....ankel weights!!!  I have gotten 4 denials and had to go to obesity law to get approved.  I hate to say it, but they will denie you because of the 5 pounds.  Have your doctor write something saying that you are at so and so weight w/ a BMI of 40.  I bet that would get you approved.  This is my phone number if you want to talk 815-544-1480 call anytime. Kim