denied-uhc dr. says i am morbidly obese but it was denied

I was denied first because it wasn't medically necessary...my second appeal with my new bmi 41 which was 2 points higher than before with also with acid reflux and urinary stress... my letter said that according to their doctor i was morbidly obese but i had an exclusion....i called my employer and unted healthcare to confirm that it is covered. The lady from my hr department says is covered if i am morbidly obese and doesnt understand y they would say that.....her exact words! So she looked into it and at first they told her it is an exclusion then she clarified it with them...then they came back to her with its not medically necessary. so i am working on my third appeal with united health care. it will be sent straight to her and she will have an independent doctor review it. any advice as to what would i should include to help my chances?

Omg! Im soory. I dont have any advice but I thought id just let you know you will be fine and it will happen! Dont worry. Just keep at it and dont let anything fall between the cracks... I was denied early April because of my thyroid but im now controling it and im hoping to be approved within the next month. Goodluck and dont stress too much!

hi :) okay so everyones plan differs but i have UHC and was approved a few weeks ago according to my plan i had to give them: *a letter of reccomendation for surgery from my PCP *5 years of documented weight *5 years of documented attempts at weight loss (weigh****chers letter stating i was a member, letter and documentation from a personal trainer, proof of gym membership, nutritionist records... ect..) * BMI of 40 or above *list of co-morbidities *2 nutritionists visits *a psych evaluation *2 support group meetings ... i think thats it... i basically just sent ANYTHING i could think of that would help me. Hope this helps and i hope you get that approval letter ASAP! :) GOOD LUCK!! -Courtney-

thanks u all for the support.....but as far as the documents i need they said i didnt need 5 year weight history, or supervised diets....just doctor recomendation,pysch eval,nutrion eval,weight loss attemps,bmi of 40 or more or bmi of 35 or more with 2 comorbidities i turned it all in and their doctor said i was morbidly obese...so im like what more do thet need? so im just collecting as much info as i can on what guidelines and criteria are and comparing it to my situation. but all ur help is really appreciated! thank u so much!

I don't know much about how your health care runs, but I have BCBS and was told that they are one of the best to have...and i was denied. My mom and I pleaded and cried on the phone with a rep asking her please to do what she could to appeal it. They were saying that my surgery was not medically necessary even though I weighed 290lbs with sever poly cystic ovarian syndrome and sleep apnea. We appealed it, and I was approved and had my surgery last monday. All I can say is please keep your head up. I know how it felt when I was denied, but if you believe in hope and guardian angels just keep praying. The day you get your approval letter will be one of the best days of your life! Stay strong and keep fighting!

"not medically necessary" is only the general denial - you and your surgeon should have received a long denial letter outlining the criteria UHC uses for approval and specifics as to why they claim you didnt meet, along with their entire appeals process - your appeal letter should be based on the specific reasons they denied you.