I sure hope they only take 5-7 days....I cant wait. My surgeon will submit paperwork Monday or Tuesday and I hope to know by the first part of the following week....I am not very patient! (I too have United Healthcare) eekk Good luck everyone.

Hm, I still don't read it that way, but it doesn't really matter, as each person's policy is different and whether WalMart insurance will pay on original submission or appeal is dependent on each person's benefits/plans they have.

Ok, so its not like I'm surprised.  I knew there was a high likelihood that I would initially be denied for revision.  The plan was to at least get the band removed (the Dr. was going to do the revision in 2 separate procedures to allow the stomach to heal) and try again with under a different policy next year (that way they wouldn't have to know I ever had bariatric surgery).  My current insurance company will not even approve a removal because I don't have any complications from the band and they don't feel I've tried hard enough to lose the weight.  (I used to feel that way too...but its been 3 yrs, and I still have diabetes and PCOS to contend with and its hard as hell to lose weight with these 2 particular conditions!!!).  I think I have a right to have the band removed if I no longer want it inside of me! Although I despise being denied, I'm not devastated or anything, but I do intend to give the insurance company a hard time until they at least agree to pay for the band removal.  How do I do that?

My surgeon's office, particularly the insurance coordinator is doing very little to help.  I asked for a peer-to-peer between the Dr. and the insurance company and all she did was try to assure me that that won't work because the insurance company believes I have been non-compliant.  I despise nay-sayers!  If I can't get them on board, I am going to another surgeon!  I think insurance companies use the non-compliant excuse to make people feel guilty about failing to lose weight with the band.  That's not going to work for me.  I have a two-fold plan.  One, I am going to appeal until I can't appeal any more, so I am going to see what advice I can get from the insurance forum.  Two, I am going to work the hell out of this band for 6 more months (or until they approve me, whichever happens first) and document everything (diet, exercise, fills, complications, and weight) myself (on a blog, so it will be time-stamped and they can't say I just made it up).  If this appeal does not work out for me, I am going to resubmit everything again in August/September.  At that point the non-compliant argument will be a moot point.  I also intend to keep seeing the psych and using the nutritionist as need be.  Hopefully I can at least get the insurance company to reconsider the removal.  If I can get that approved, then I will keep the removal in my back-pocket ****il the end of the year) so if showing compliance doesn't work, I can go back to my original plan of getting the band removed this year, and reapplying for bariatric surgery next year under a different policy.

I am sure you will get a letter, but I would ask them specifically for the documentation in your policy (or certificate of coverage) that excludes WLS coverage for those under 21.  I see no mention of it in their online medical policy (Policy Number: 2012T0362P; Effective Date: December 1, 2012).  It might be listed in your specific policy or cert of coverage, but usually those 18 and over are covered.

This might just be them grasping at straws to try to deny you on the first go around.  I think your doc would likely be successful on his appeal - there are just too many studies showing the benefits of surgery, especially on the younger patients.

Good luck!