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HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
what state do you live in? I'm also just starting the process of trying to get wls, I live in NV and have medicaid/amerigroup
Just starting process of trying to get wls, has anyone actually gotten approved and had surgery in Nevada? I need any help I can get.
Have you hooked up with a surgeon yet? They usually have an insurance coordinator who knows all the ins and outs, and they will submit the paperwork to insurance for you. Once this is done, if it is denied, it will be denied in writing - then you will know the reasons why, and you can appeal.
Alternatively, if you don't have a surgeon yet, I would gather all your letters from your doctors, your medical records showing your BMI for the last 2 years and that your weight is the cause of your diabetes and high blood pressure, and a letter from your PCP or other doctor stating that the surgery is medically necessary to treat your diabetes and high blood pressure. Then, send it all in (make copies!) to your insurance company. They will write back with either an approval or denial, which you can appeal if necessary.
Good luck!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
Hello there, So today I started two additional medications and now up to 8. This is for blood pressure, diabetes and not sure what else they are trying to control except for these two things.
I have the support of my regular doctor. I went to see a cardiologist to make sure I was healthy enough for the surgery and that my heart was in good shape. This doctor is also a true believe and feels I am an excellent candidate. We contacted OWLLS and were told that the insurance will not pay for it. I do have an exclusion for weight loss surgery. To get around this I was told to have everyone go in with angles of all the needs to be done to remedy what is wrong.
I have never gotten a letter from anyone saying NO. I only get this over the phone. How does a person get past the main people answering phones? Get someone to look at all the records?
Anyone in Oregon know any way to get around this or some advice?
Thank you,
Dean
I don't have any information, but I wanted you to know that I feel your worry. Hopefully someone will have an answer for you. When did you hit the 40 BMI? I have heard insurance companies that have a written policy of 5 years 40+ BMI, but really will accept a 2-year history on appeal. Good luck!!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
I am really concerned with United Healthcare approving my surgery. One of the requirements is 5 years of morbid obesity documented. I believe morbid obesity is considered a bmi of 40 plus. I have a bmi of 40 this past year, but the previous years started at 36 and keep going up till now. Does anyone know if UHC are real sticklers on that? I have about worried myself sick over it. I meet all the other criteria except this one.Thanks for any information anyone can give. Thanks.....
Hockeymom87 · 0 replies · 662 views
