Question:
Anyone else having problems with appeals from UnitedHealthCare Choice Plus?

HELP! I'm soooo totally clueless on how to go about writing a letter to my insurance company to cover this surgery for me. Has anyone dealt with UnitedHealthCare Choice Plus of Ohio and been denied then approved, and if so, how did you go about doing so. Was it a long process? Please help me. I have a meeting with my PCP on Monday and she said she would write a letter for me saying my health is declining because of my weight. I have high blood pressure, cramping in my calfs, periods that come once a year and last for three months, I'm a candidate for cancer, and I have severe depression which has lead me to be on anti-depressants for six years. If anyone can help me I would deeply appreciate it.    — Tiffany Jo W. (posted on October 19, 2001)

October 19, 2001
First, find out what your insurer's requirements for wls are and then your doctor's letter should address each requirement. For instance, if your insurer stipulates a bmi of 40, co-morbidities, diet history. You doc's letter should give all this info in a clear and concise manner. They aren't interested in what you "might" get or in how you "feel". They just want clinical documentation that fits their requirements for approval. Please refrain from mentioning your depression. Some insurers also look for evidence that the prospective wls patient is emotionally secure enough to stay compliant, to adopt the necessary lifestyle changes and to understand the need for lifelong medical follow-up after wls. You don't want to cloud the issue by volunteering info about your depression. Many insurers have dropped manadatory psych evals.
   — [Anonymous]

October 19, 2001
I have the same insurance and my clinic said they are the best at approving this surgery if it is needed. I did have co-morbs too, also in antidepressants for years. I also had a sleep test, psyc test, etc. Had to have approval by my pcp too. DO NOT GIVE UP TRYING! Good luck.
   — [Anonymous]

October 19, 2001
Hi - The first thing you need to do is to get a copy of your policy and see if it lists an exclusion when it comes to WLS. If you do have an exclusion, I'm afraid you're out of luck and might want to look into self pay or changing insurances. An exclusion is the ultimate out and UHC loves to use it. If there is no exclusion, then you need to bug them to death to get approval. You might also want to get letters from other specialists detailing how important this surgery is for you.
   — [Anonymous]