UHC Question

Hi all,

I am faily new to the board mostly spend my time lurking, but I wanted some info from anyone who had UHC or a similar situation.

I submitted everything to my Dr's office with the exception of my psyc eval which I am going to in March. When the financial counselor reviewed everything she said she thinks I will be denied because of the " Diagnosed as Morbidly Obese for the past 5 years (documented in Medical Records)" requirement.

I submitted 8 years of records only problem is for part of it my BMI was under 40 but within the 35-39.9 however at the time I was not diagnosed with any co-morbids.
I have met all other requirements and have a good recommendation from my PCP for the surgery. My co-morbids are Severe sleep apnea with a AHI of 126.2 (they only require >30), I have hypertension, PCOS, anxiety which is weight related and high cholesterol. My dr also feels I am headed for Diabetes II.

Has anyone been approved when they didn’t fully meet this requirement? I know I can appeal it if I am denied, but I guess I just want some hope that I wont have to go through the hassle.

Thanks,

Teli

I used to work for 2 bariatric surgeons and got several hundred people approved.
You are sending too much medical records.
You need to go through all of it and pull out the highest weight for each year of the last 5 years. It does not matter if it's from a dentist, chiropractor, what ever. One weight per year for the last 5 years, thats it. Submit that and only that. You do not need to submit 5 years of medical records, its not necessary. They dont care about evey sore thoat or cold you had!
Usually when I sent out requests for surgery, the whole packet, including the 6 month diet was only about 20 pages.
If you pick out the highest weight from each year, you might be suprised to find your BMI was above 40 at least one time during each year. It does not matter if one weight was from November 07 and one from Jan 08, they are 2 different calendar years! Also make sure you have been accurately measured height wise. I had one lady insist she was 5 feet tall and actually she was 4 foot 11, and it made the difference for her approval.

Good luck!
Bonnie

I have a question about the height issue... during basically every weigh-in I have documented since elementary school, the nurse weighing me would just ask me how tall I was..... and being overweight and ashamed of the number on the scale, I'd add a few inches. If the 5 year history I need to submit includes inaccurate height, can you correct that?

I used to do the same thing and when I went in to see my bariatric surgeon they actually measured my height on a chart and to my surprise I was even 1 inch shorter than I thought and it upped my BMI. The paperwork the surgeon turns in is what counts, not ur drivers license or any other medical stuff.

Let the surgeon know whats going on and they will take care of  it.