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]
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