Deniee-for the second time!!!

Denied by UHC-for the second time and for the same reason.  I don't have 3 years of medically supervised weight Loss under my belt.  I don't understand the denial.  I had a wonderful appeal letter and my doctor wrote to say this would save my life.  But-I am not upset on the denial so much as upset at how they did it.  The first appeal was to be done by a independent doctor in a related field.  You want to know what the doctor's related field was???? Cardiologist and thyroid specialist.   REALLY?????  How related is that????    I am so mad I could spit!!!!  How do I do this second appeal.  I tried to show I had all these years of trying to diet.  I showed on paper I had years of different diets, weight loss products, medications-but no!!!  This insurance states that it has to be 3 years consecutive medical supervised weight loss program.  What do I do???  I can't think, I can't feel anymore.  I am willing and ready for the fight, but I don't know if I will just hear the same answer again.  Anyone else dealt with this?  Any information would be helpful.

Thanks so much

Linda

This can be a really frustrating thing to go through. Don't give up!  If you have not done so, please post this on our Insurance, Cash Pay and Financing Forum.

They do have every right to insist you meet their requirements.  Medically necessary or not, you have to meet their requirements.  The state ins comm would side with them, it's part of the policy.  All they would do is make sure your ins co is following the policy to the letter.

There is always self pay or doing the 3 years.

BTW... the cardiologist is totally capable of reading medical records and determining if there is 3 years of medically supervised dieting there or not.  Shoot, a medical assistant could do that, too.  :o(

That is really rough!  Three years!  I did have to show 5 years obese and many weight loss attempts but, I only had to do 6 months supervised.

I would consider contacting Lindstrom's advisory group on help with your appeal. You only get so many appeals before the final denial. They have a good track record of appeals.

You're a revision patient?  Did you have annual visits with your physician/surgeon after surgery?  I would think that would count.