Uniform Medical Insurance

Has anyone had WLS approved through this insurance company? If so it will help me in my next level of appeal. Thanks Pat

-I personally do not have this insurance but I did some research for you hope this helps (go to insureres and click on your state) then you can e-mail these people personally Kimberly------------------------------------------------------------------------------- Uniform (Washington State) Approved after appeal letter (08/31/01) Open RNY - proximal Weeks to approval : 6 Pre-Op BMI : 64.0 Comorbidities : Sleep Apnea, Osteoarthritis in joints, Gall bladder disease, GERD Policy : Written exclusion policy Comments : The customer service unit is wonderful. They will assist you as best they can, but there is a clear exclusion in the State Policy for bariatric surgery and will only approve surgery if medically necessary. The definition of medical necessity is very tough. Anyway, They automatically deny on first round and if they feel there might be a medical necessity they send you to another physician for a second opinion. If you write a clear letter of appeal outlining how and why you feel it is medically necessary and the second opinion from the surgeon states that if you do not have the surgery your life is at risk then approval can be yours. You must be very clear with your reasoning and it is only a recent change that Uniform is approving these surgeries. Patients must be very clear and definate about their commitment to the life style change. I say appeal, there is now a chance of approval! Source: E S -------------------------------------------------------------------------------- Uniform Denied after first letter (08/06/03) Weeks to approval : Pre-Op BMI : Comorbidities : Policy : Comments : Source: Judy Oliver -------------------------------------------------------------------------------- Uniform Approved after legal action taken (6/30/01) Open RNY - proximal Weeks to approval : 28 Pre-Op BMI : Comorbidities : Diabetes, hypertension,hyperlipidemia, metabolic syndrome Policy : Written exclusion policy Comments : I think hiring an attorney helped a lot. I hired Walter Lindtrom at www.obesitylaw.com. My first two appeals were quickly rejected (getting the rejection notice within one week of sending the appeal). It felt like after I hired the attorney, they finally sat down and really read my appeal (they might have done this anyway but its hard to say, all I can say is that the attorney worked). They then required me to go for a second opinion and then required me to use their surgeon (who is wonderful- so no problem). I am the first person that I and many others are aware of to have them actually cover the surgery, so I think they are making some paradigm changes. They stated in a letter to me that they are considering making a policy change and starting a program with strict critria...but that it would be another 18 months or so. So, any Uniform subscribers...do not give up hope...Appeal!! Source: Nancy Douglas -------------------------------------------------------------------------------- Uniform Approved after 2nd appeal letter (10/21/02) Weeks to approval : 40 Pre-Op BMI : Comorbidities : Arthritis, hypertention, GERD, Diabetis, high cholesterol, Sleep problems, etc Policy : Written exclusion policy Comments : They were strict as to following procedures to get an exemption. It took three appeals after the initial contact. They stall enough that some people might give up and go away. Yes. Follow there procedures exactly and be persistent, friendly, accomodated and kiss butt. Source: Carol Prentice -------------------------------------------------------------------------------- Uniform Medical Approved after 2nd appeal letter (12/14/03) Weeks to approval : 16 Pre-Op BMI : Comorbidities : sleep apnea, GERD, hypertension, high cholesterol, reduced lung function Policy : Written exclusion policy Comments : From the time I started seriously considering WLS to date of surgery, it was approximately 10-11 months. During that time I got all the tests required, checked out surgeons, went to support meetings, and worked at getting as near a perfect medical packet to submit to Uniform Medical as I could. From the time it was submitted to approval was approximately 16 weeks. Even though the policy has a specific exclusion for WLS, they also have a medical necessity clause. I was able to prove to them with documentation that this was a medical necessity. My co-morbities included high blood pressure, high cholesterol, severe sleep apnea, GERD, reduced lung function, and depression. If you have Uniform Medical, just assume you will be rejected twice. Do everything you can to include everything they will need, so you don't lose time by them having to ask for another test, etc. The key is to have your appeal letter all ready, so when the first rejection comes, you send your first appeal letter by return mail. Same with the second rejection. This cuts down on the time to approval and lets them know that you are not going to give up. After the second appeal, they appointed me a case manager to work with me. All in all, they were very good to work with and I never got a negative attitude from them. They were very nice to work with and I felt that they wanted me to get the approval, I just had to meet their requirements for medical necessity. I have heard, however, that the "popularity" of this surgery is growing and the insurance companies (including Uniform) are cracking down and will be making it more difficult to get approval. This will probably include a 6 month supervised diet (maybe two) with documentation. Don't let that discourage you. It goes by quickly. I had an open RNY on 12/2/03 and couldn't feel better. Good luck. Source: Wanda P. -------------------------------------------------------------------------------- Uniform Medical (PPO) Denied after 2nd appeal letter (02/27/04) Weeks to approval : Pre-Op BMI : Comorbidities : Policy : Comments : Source: Diane Ronaldson -------------------------------------------------------------------------------- Uniform Medical Denied after first letter (03/04/04) Weeks to approval : Pre-Op BMI : Comorbidities : Policy : Comments : Source: Pat Hayett -------------------------------------------------------------------------------- Uniform Medical (Uniform Medical) Denied after first letter (10/27/03) Weeks to approval : Pre-Op BMI : Comorbidities : aortic stinosis,hypertension,arthritis,cancer, graves Policy : Written exclusion policy Comments : I have only been denied once so far. They have moved very fast, I don't know is that is good or bad. In less then 3 weeks we have notified them of the request and they have denied the first time, and have received the request to appeal. I will update as this progresses, I would suggest anyone with this insurance move very quickly, they are absolutely not going to cover this next year. Source: RoseMary Delaney -------------------------------------------------------------------------------- Uniform Medical Insurance Approved after 2nd appeal letter (08/21/03) Laparoscopic RNY Weeks to approval : Pre-Op BMI : Comorbidities : Severe Obstructuve Sleep Apnea, Insulin Resistance, PCOS, HTN, etc... Policy : Written exclusion policy Comments : Uniform Medical Insurance has a written policy exclusion. Dealing with them this second time around was not bad at all. They were prompt to notify me when they received information or letters from me or my providers. I appreciated the promptness in dealing with my appeal. They automatically deny the first request. I think they want to see if you will follow through with their appeal process and when they find out your serious enough they evaluate amongst their appeal committee. I followed through to the 2nd appeal ladder. With faith I truly knew in my heart that it will be approved. All I can say is appeal, document and appeal. Be persistent. And most of all PRAY, the power of PRAYER is awesome. Source: Victoria T -------------------------------------------------------------------------------- Uniform Medical Plan Denied after first letter (06/17/01) Weeks to approval : Pre-Op BMI : Comorbidities : Policy : Comments : Source: PK Bailey -------------------------------------------------------------------------------- Uniform Medical Plan (PPO) Approved after 2nd appeal letter (3/6/03) Open RNY - proximal Weeks to approval : 8 Pre-Op BMI : Comorbidities : diabetes, HBP, GERD, Policy : Written exclusion policy Comments : The Dr. office just sent in the 2nd appeal. I am hopeful that they will approve this time. It has felt at times maybe they hope I give up before they approve. I do believe that they are trying to be equitable and fair. There is a clear exclustion in the policy. March 16, 2003 Today I checked my mail and I have been APPROVED for surgery. I am so fortunate. Maybe some day there will not be an exclusion for this surgery. Source: Victoria Tenney -------------------------------------------------------------------------------- Uniform Medical plan Approved after 2nd appeal letter (03/29/03) RNY Weeks to approval : Pre-Op BMI : 57.7 Comorbidities : Sleep Apnea, hypertension Policy : Must be medically necessary Comments : I had to call several times. It seems like they were trying to stall the procedure. Persistance pays off here. Just make lots of phone calls. Become a thorn in thier side. They denied the request twice and then I was assigned a case manager. She was VERY helpful in telling me what I needed to get WLS approved. It also helps to have a PCP that knows your past medical history. Good Luck!! Source: Benn Larson