Denial letter from UHC said...

Wendy, Go get that sleep study sounds like you may have sleep apnea. Also maybe have a blood work up for diabetes all these things sleep apnea and diabetes are co morbiditys.                                                            Annie

Hey Annie! Gonna do the sleep study, I know I don't have DM. I'll give 'um a run for their $$$$  LOL

Hey Wendy - All insurance companies has a clause if you well that if your BMI is 35 - 39.9 you must have a MAJOR co-morbid condition, like high bp and being treated for it, sleep apena again being treated for it. These are what they are looking for unfortuantly the pains we live w/ daily don't cut it for the insurance companies. I guess they really don't care how much pain we are in just living day to day.  Here is my suggestion see if your PCP can do a peer to peer. A lot of times the surgeons have only met you the one time and your pcp has followed you for years. If you don't want to request that then yes appeal. You will probably get turned down pretty quick becuse those that appeal stays w/ in the insurance company. You will probably have to go to a second level appeal which goes outside the company. Now I would like to say you would get approved but if you prove your case good this is where I have seem most people get approved.  Good Luck!!!!!

Thanks for your help! I will get documentation for BP with medications and probably high cholesterol too. I'll get the sleep study scheduled this week hopefully!

So sorry, Wendy, but you must appeal it. I was going to tell you what Suzanne already did about BMI. Keep plugging away. You will be rewarded in the end. Sending hugs your way, honey. After Tuesday, I will be waiting to hear from insurance company...also UHC. I have BMI of 61, sleep apnea, hypertension and arthritis. Never thought I would be thankful for that. I am hopeful, but as I see, anything can happen. Chin up, sweets, Mary Ann

Mary Ann - Best wishes too you! I hope you get a quick reply, will be waiting for your post!

Good luck finding those co-morbidities Wendy!   I hope it goes smoothly and quickly this time.  Frankly, your doctor's office has probably submitted enough of these to your insurance that they know what was needed, not to point too many fingers... Anyway, take care and keep us posted.. Ellen

Ellen - I hear ya about the Dr's office. They get you in and you pay your $$ and they got ya, unless you want to forfit your $$ and go to another Dr. We'll see what happens - Thanks!

Here is some hope for you... I didnt meet my insurance company requirements and was approved... I did have to go thru the entire appeals process but on my final appeal I was approved. Many times the insurance will deny the first time... it happens to everybody... just get working on that appeal :-) keep it to the point... they want to know medically why you need the surgery... they (for the most part) dont care if you were picked on as a child or didnt get asked to the school dance or anything... I approached my appeal like a science paper... since I didnt have any major co-morbs... I had to write about what things I did have and how losing weight could help them...  Just keep your head up and keep jumping thru those hoops!

Thanks J.K - I will!