hey i was just wondering how long does it take for khpe to approve you for the surgery? and what are all the requirements that you have to past in order to be approved? just a little nervous and just waiting

I have read some articles that state exclusions can be overcome due to the covered things such as hypertension, sleep apnea, etc. However, I don't know how they did it. I hope some people on here can give some good advice.

Although my doctors have listed RNY surgery as Medically Necessary, My insurance is denying my claim due to a exclusion clause. Treatment for Obesity including surgery is not covered. I have several co-morbidities such as insulin resistance, hypertension, secondary hypothyroidism, sleep apnea to name a few which my insurance is suppose to cover. I'm on over 200 dollars worth of medication (and that is with my co-pay). The only explaination of not covering this treatment is "We will not pay for benefits not covered for exclusions even if recommended by your physician and is the only available treatment for your condition." They went on to say, "federal and state laws (I live in Florida) require UnitedHealthcare to strictly administer the terms of your health benefit plan. We may not deviate from the plan terms of your Benefit Plan." My HR department has stated that they will not change the policy to include this benefit, but they did ask me if I had appealed. Does anyone have any suggestions for me? I'm at a loss.

In order to know exactly what you need, you need to call your insurance company and either request their bariatric policy book in paper form or direct you on their website where it can be found. The requirements will be listed but doing them to their standards will be diffcult. When you are on your diet, record everything from what your dietician tells you to eat, weight, bmi, recommended exercises, recommended lifestyle changes, changes that you have made and keep a food log. If they provide you with any documents, submit. Make sure you get a letter from your dietician and your pcp recommending the surgery due to a failed 6 month diet. Hope this helps.