Help - Denied

Hello all. I was denied by UHC stating WLS is not covered. I have 180 days to appeal and my head is just spinning. Needless to say I'm shocked, but want to fight this battle. Has anyone else been denied and then approved on appeal before? Any suggestions on how to go about this would be welcome. - Cherie

Cherie, Hi, I am so sorry to hear about your news, just remember where God closes one door, another is opened. My prayers are with you. I have heard that several people have been denied then they submit letter for appeal and it goes through, just dont give up! I am pre-op and in the waiting stage and I'm not that familiar with how things work just yet, but I just wanted to post to let you know I care and am thinking about you. I found quite a bit of help and answers on this one site, here is the info, it also has some nice sample appeal letters. best of luck to you and please keep us posted. http://mygastricbypass.com/appeals.htm **hugs** Kim

Thank you, Kim. I had visited that site and saw the appeal letters. It gives me the opportunity to put more doctors together. I'm not going to give up, definitely had a moment of self-pity. Cheryl

Cheryl- Appeal, appeal, appeal !!!!! The insurance companies want us to feel defeated and give up, don't do it! There was someone on here who has UHC and they approved this week. It can happen. Good luck

Thanks, Amy. I will appeal. It is so frustrating to have to even do this. People treat us like we want to be this way and that isn't the case at all. Thanks again. Cheryl

ohh girl im so sorry... keep ya head up... and be brave... ohh yeah.. and APPEAL!!!!!! Lexa

Sorry to hear it United Healthcare is strange. They approve some and not others. I think it depends on the type of plan you have with them. It also depends on your employer in a sense (depending on what types of coverage they want open for you to choose). Some say it's covered if medically necessary, others say it isn't covered. Check into your plan and find out. Definitely appeal. From what I hear, when you appeal, you usually get it approved. It's not the end! You just gotta fight harder!

Thanks, Marcie. I'm putting together an appeal right now. I am not going to give up, just fight harder as you say. - Cherie

What type of UHC do you have? EPO? PPO? etc. From the way UHC has explained to me, UHC does cover the WLS but it depends on if the company you work for bought the coverage. A previous job I had also had UHC and I was told that the surgery was not covered at all, but then when I got this job, I also have UHC but found out my employer bought the entire UHC coverage whi*****ludes the surgery. Unfortunately, if it is that your job didn't purchase the coverage for WLS, you may have a hard time with the appeals. They told me I would have to fight with my job to have the coverage added and that there was nothing else they could do I hope for you, there is a different answer! I wish you the best of luck and me and my family will be praying for you and yours! Please don't hesitate to shoot me an email if you ever need anything!

Dear Cheryl, I was denied. Then I waited for my Dr. office to appeal--poor choice, they didn't. This surgery was for me and I needed to do it. I felt I didn't know enough. First, I went over the grounds of why they refused me. I knew I had to address that first. I did a lot of research on the internet with Dr.'s inputs and studies --so that I could quote them on why this surgery was necessary for me. Then I read, and read the input from others who have had the surgery. What I learned is different aspects that affected my life, and feelings I had that were the same. They helped me put it into words. I then pulled it all together and submitted it. I was pleased that they did approve my surgery. My date is May 4th. Don't give up. Pray as if it all depended upon God, work as if it all depends upon you. Good Luck. Cindy