Denied by UHC

Hi Everyone,
I've been quietly on these boards getting strength and advice. My surgery date was supposed to be on 4/2 for VSG. I just got denied by UHC and I'm completely devestated and feeling so hopeless. I would love any advice, and any stories of those who got denials eventually getting approved to give me some hope. Thank you so much. Ann

Please provide more details:  which UHC insurance program, height, weight, comorbidities, reason for denial, etc.  There are lots of people that have been through denials and still got approved after appealing or providing additional documentation.

Thank you so much for your reply. Ok. I'm 5'4" and my bmi has ranged from 36-40 for the last five years. They said that basically, I haven't been fat enough for long enough, so there was no medical necessity. I am a lifelong asthmatic, and have been on depression meds for 5+ years. I don't have high bp or diabetes, but I have both on both sides of my family, and I have been told I'm at serious risk for diabetes because I gain weight in the middle and have those lines on the back of my neck. I'm so sad right now! It is so hard to go through the 6 months of doctors visits, and all the other hoops and then get denied.

Asthma, depression, and a family history of diabetes are not what ins co's are looking for.  They have very specific comorbids they require for you to have WLS benefits.  Usually sleep apnea, diabetes, and high blood pressure (all needing treatment, pre-diabetes and such don't count) are typical for most ins co's.

Gosh, there are so many different policies with different requirements.  Mine is  a UHC policy through the state of Georgia.  In my instance, they specifically state (via my bariatric nurse assigned by UHC) the co-morbidities that are recognized by UHC. (heart disease, high cholesterol, high blood pressure, sleep apnea).  Even after recognizing those specific comorbidities, there are certain LEVELS of  disease that have to be met to be accepted as a comorbidity.  You really need to get the specific information from UHC for your specific policy (something that I have STRUGGLED to get from my UHC policy!!!).  

Lots of people of the OH board have advised me that if you work at it and document it, you can meet with your PCP and find/recognize comorbidities that you might otherwise have not known you had. In my opinion, that would be the first step I would take.  Then at some point you may need to work with your surgeon's office to file an appeal with the insurance company.  Whatever you do, I have learned from the purple hearts here on OH, that you should NOT give up.  There ARE options.  Keep us all informed and include all details so that those who have been through this can advise you and counsel you.