Denied by United

I was denied by United. I have papilledema and Pseudotumor Cerebri (aka Idiopathic Intercranial Hypertension) The letter I got said that there is no proven results of WLS. The letter goes on to say that WLS is for hypertension, CV disease, diabetes, hyperlipidemia, sleep apnea. But no where did it say anything about my PTC. The letter acknowledged my BMI, (37) but didn't acknowledge what WLS did NOT cover. I'm wondering if my doctors office forgot to send in some paper work. I did a quick search on the internet and pulled up many articles and studies of WLS and Severe Obesity totally reversing PTC. Will this work? These articles are from reputable sources, sources physicians use on their own . PubMed,  NIH, MedScape, Telemedicine. I plan to submit an appeal. I'm just afraid that after my doctor and I show them it is PROVEN, then UHC will come up with another excuse. Can they do this? Can they keep coming up with excuse after excuse or is their inital denial letter what I have to contest to? Do I have a  chance with UHC, or are they one of those "gotta be knocking on deaths door" before they will help. Do I have to lose my vision, have a heart attack, become diabetic, be put on a CPAP, have a BP of 220/110 before they will consider me? Are they a pain? Lis

I don't Know for sure, but I have heard that With United Healthcare It really depends on your employeer because each employeer chooses thier own policy on coverage of Bariatric surgery. I would ask you Hr person for there written policy

Ever since UHC bought my HMO I've been dealing with this same s***.  I'll keep you updated on my fight.

I am in the same United boat.... I was just denied today; but was told its because WLS is not in my policy. Now we all would not go through all the pre-testing and what not if we did not have this coverage in our policy. I was told twice when I called United and my surgeons office called with surgery codes to make sure i had coverage before i began this lengthy and pricey journey.  After my surgeons wonderful office manager fought with United for over 2 hours screaming at them she was basically told there representatives made a mistake and im not covered, they are sorry and will retrain their representatives on explaining policy to consumers.. I was told i can not have a specific copy of my policy in writing because it is not available to the public. So after I cried for an hour today and realize i am now destined to be super morbidly obese forever. This sucks. After 5 1/2 years with this company I think its time to find a new job based on health insurance coverage. GOOD LUCK TO ALL OF YOU

This is not true. They HAVE to provide you with an explanation of benefits. Call back and keep going through the supervisors until you get the top and keep pushing for them to send you your plan benefits. They have to provide them to you in writing.

Very similar story here.  I have UHC and my company has a written exclusion for WLS in the policy. The surgeon's administrator told me flat out that if there is a written exclusion it is nearly impossible to appeal it.  I suspect that it would take a legal battle to even come close to winning being approved.  I just don't know who would have the fortitude to deal with a legal suit. For me, I am either going to forget the whole idea of losing weight and try to come to grips with dieing early, or find someway to fund it privately. KRE

I have had united for many years. I have had friends who has WLS paid for by united. I called them also and the lady assured me that my WLS was covered 100%. The denial letter stated I was denied because WLS is not a PROVEN TREATMENT and the policies exclude UNPROVEN TREATMENTS. My Surgeon said ABSOUTLY not. Actually there are many studies that WLS is a CURE to PTC. I'm going to appeal and hope that they don't come up with another reason to deny me. I'm starting a job with a new employer, a hospital, but they have United also. DH may be able to change his insurance. I think they have 2 or 3 to choose from.  Ironically- I have always told everyone how great united is. Working in an ER for many years, united was THE most pleasant insurance to deal with. My mind is changing. The health care in this country is so messed up. Uggggggggggggggggggggggggggggggggggggggggggggggg.

im no lawyer, and im sure Gary can advise you much better but........those articles sound like they couldn't hurt your case. also what about your family history? is there a history of diabetes? heart disease? because if you are young and healthy NOW.............a predictor of what your future will be like if you stay at this weight is to look at family members who may or may NOT be obese. i have a history of diabetes and of heart disease in my family.. in my IMMEDIATE family and i am damn sure going to mention that. it's probably harder for you also because your BMI is 37 and not 40 or higher.

You might want to contact Mercy Q. in the VSG forum. She fought and won an exclusion with the insurance. If you want it, don't back down. No one else is going to fight for you until you make yourself a pain in their ass. If you REALLY need to self pay, try CareCredit.com But I would appeal. Don't back down.

I have care credit already. They would need to increase my credit limit though. If it comes to the point of "self pay" then the surgery is going to have to wait. I'm starting a new job and will have to save a lot.