UHC - Denial -- Peer to Peer or Appeal????

I am in Franklin -- I have UHC insurance -- they said that the only requirement I needed was a six month diet -- FYI -- i have already done the psych, nutrition, IQ test, physical, etc...-- I did the diet but in the middle my doctor had to cancel my April and May visits.  My June visit was suppose to be my last.  Since I knew that may be an issue, I went ahead and did a July and August visit.  That being the case, my surgeons office sent in my paperwork.  UHC denied it today saying with wasn't consecutive. 

Options are:

Peer to Peer --

Appeal --

Lay down and cry --

If I appeal or do Peer to Peer and am denied again, I am being told that I cannot try again for a year.  What should I do?

The other issue is that my company may change insurance companies in the new year -- that could be good or bad.  It's all such a gamble.  Help!

Not sure what Peer to Peer is but you could just continue doing the diet for the next 3 mths then you will have your 6 mths combined.  That is so ridiculous that they are THAT pcky..  Sorry you are having insurance issues.  good luck and don't give up

Hi Kelly,

I know it's almost unfathomable to think of going another 3 months and extending the process, but I agree with the above poster...maybe you should just continue your visits and make them consecutive and then reapply. An appeal might take just as long and if you were denied a second time, then who knows how long you would wait? I'm so sorry you are in this position. The surgeon's office should have known that and informed you. :( Hang in there. Surprisingly, 3-4 more months is probably a drop in the bucket compared to living the life you want to live after WLS. Take care!

Laura

i have the same insurance. my doctor messed up my weighins too. i had to start all over and do the 6 months again. i was so frustrated but i got through it and had my surgery. you will too. just go 3 more months in a row and it will be what they want. good luck.

I know that some ins. plans definately do not allow any break for any reason so I say ask if you can just do the extra 3 months. I wish that is what had done years ago when I was denied for changing Drs. I would have had to just do 3 more months but I got upset and gave up... big regret. Ask what each process is and make sure you know how it has went for others who have done these processes. But if it was me, I would ask can I just do the 3 months instead?

I have UHC insurance......I live over by Knoxville. I also am an RN Case Manager for an insurance company. Do not do the peer to peer, statistically the numbers are stacked against you for getting another denial. Don't do it.

Definately do the additional 3 months. Its less of a headache.....and my hope is after that you will be approved. Good Luck......

I'm on track to get my surgery done sometime Nov/ Dec......I'll be curious as to your outcome with the insurance !

Thank you for all the replies!  I have decided to do the next three months.  I will finish on November 1 -- I checked in with my work and they are not changing insurance companies so that is a big relief.  I am thinking January would be a good time.  Right after the holidays and my flex spending account will be full -- I can carry over the vacation time from this year that I have been holding onto.  I really appreciate everyone's stories though b/c that helped me decide what to do and be ok with it.  Thank you.  kmb

Hang in there. Everything happens for a reason. God has a plan for you, but just not on YOUR timing...(its frustrating to always has to trust in his timing sometimes !!!)  But this is all for the best..........Good Luck and please update us at a later date.