Received my denial letter on 3/8/04 from Uniform Medical Insurance

Just received my denial letter stating that this procedure is an exclusion. I sent my appeal letter to Uniform Medical along with a letter from my surgeon, general practitioner, endocrinologist, sleep disorder doctor, and podiatrist all stating that this surgery is a MEDICAL NECESITY. I'm a male, 5' 10", weigh 330 lbs and my BMI is 50. My sleep disorder specialist states that I'm one of the five worst sleep apnea patients he's seen in 18 years of practice. I'm unable to use CPAP machine. My employer also supplied a letter stating that my falling asleep is causing a lot of problems with the quality of work I produce and if the problem is not addressed it could cause me to be demoted if not discharged. My physician and endocrinologist state that my Type 2 diedeties is out of control and having this surgery will solve this problem. My quality of life is shot. I have a 9 year old boy and two girls 8 and 4 who I'd love to play with, but I have no energy. I come home from work and don't have any motivation or energy to play with my kids let alone do chores outside (small farm) or help my wife. She has become discouraged. It has taken a toll on her because she has had to pick up what I can't do. My appeal letter was 6 pages and then another 8 pages from doctors/work/lab tests that support this surgery. I cannot call the Health Commissioner for the state, because Uniform Medical is a State run medical insurance company and does not regulate them. The health commissioner regulates all the other health insurance companies in the state like, Group Health and Blue Cross. Very depressed Pat

Pat, So sorry to hear about the denial...Are there others that you know with the same insurance, that have had the surgery? I have heard that if you can prove they have paid before, they may have to pay again....but not sure. Just keep trying...I am fighting with my insurance at this time for an approval also...cigna....uuuggghhhh... Good luck, Bettye

Hi, There is some info somewhere on this board about legal help from an attorney who had wls. I am sorry, I can't think exactly where it is, but perhaps you could find it and contact this person. It's really strange. On the news I keep hearing about how obesity has gotten to be like in epidemic proportions but insurance companies won't allow wls. There's something wrong with that picture. I think it all goes back to the stupid stigma thing. LM