denied- UHC

Hi there- I was denied by UHC. I have written an appeal letter and I would like everyone's advice on it. My doctor's records were destroyed prior to 2004 so I think that is why they denied me.  I don't think that is fair!  I am not at fault for the doctor's losing my records so why should I be penalized?  It is so frustrating!  Please let me know what you think- I can not wait to get approved!

April 5, 2007

United Health Care

P.O. Box 30575

Salt Lake City, UT

84130-0575

To Whom It May Concern:

 

            I was denied for laparoscopic gastric bypass on 2/13/2007.  My insurance plan states that I must-

 

• Have a minimum BMI of 40.
• My current BMI is 47.
• Have documentation from a Physician of a diagnosis of morbid obesity for a minimum of 5 years

o       Enclosed are my medical records dated back to 2004. My doctor’s office switched from paper records to computer records in 2004 & all paper records were lost to water damage. I am not at fault for their loss of records and I would like to ask that you review the enclosed letter stating that I have been his patient for 10 years and that I have been obese dating back to 1997. The letter is an official document signed by my primary care physician.

·        You are over the age of 21.

o       I am 22 years old.

 

I have suffered from obesity since 1994.  The toll it has taken on my body is one that is very painful. I have family history of joint pain, high blood pressure, and obesity.

 

I have enclosed information to prove that I in fact meet all three of the requirements asked of my insurance plan. Please review this information & process the approval. If you need any more pieces of information, I am more than happy to give any extra documents that you may need. I look forward to the news of my approval.

Try to think of times that you might have gone to the emergency room or an urgent care center.  If you have been to one of those then perhaps they weighed you??? Also do you have an old driver's license that has your weight on it? (that is of course if you stated your true weight...I never do)  Then perhaps pictures through the years might serve as back up for your doctor's letter. 

 

 

Before you send in the letter, wait for the denial letter that states exactly why they denied you. I was denied by UHC for lack of a 6 mo.MD supervised weight loss program. The info was there in the file they had on me already. We re-submitted everything in appeal, then I got approved(when a new set of eyes looked at the info!!) This process took 3 1/2 months. In the mean time I had the oppurtunity to change insurance carriers. The new company approved me in 3 days!! 3 weeks later I got the approval letter after my appeal, from UHC.

Good Luck and Fight, Fight, Fight!!!

Patty

Patty, My insurance carrier GHP(HMO) does not cover any obesity surgry procedures.  What insurance did you switch to that covered it.

I have a feeling I am going to have the problem with the 5 year morbid obesity thing...although I was severly obese, just not morbid, only morbid for the past 2 or 3 years.  Keep us posted on the outcome for those of us getting ready to send in our request with UHC. Thanks, Cara