Denied!

Called to check in today and doc's office said they got a denial phone call from UHC. The reason they told me was because I did not have BMI >40 for past 5 years. Have to get the denial letter and fax to doc before we can launch an appeal. The kicker is that I did doc-supervised weight loss on and off since 2008 and now my weight is 35 with comorbids. Sigh. this is such BS.

Please feel free to share your appeal stories with me. I would like to know what I am up against.

It is a shame and I hope your appeal is approved. The truth about losing weight presurgery is that the lower BMI can cause surgery to be denied. Such an unfair ruling and I wish you the best.

Do you have any co-morbidities? like diabetes, or high blood pressure or high cholestrol, these things matter with the Insurance company.  You need a two year weight chart showing UHC what your weight has been in the last two years, I work with the insurances for bariatric surgery, these are the things they look at, call you primary care office and ask them to fax your doctor any weights from the last two years.  I have never heard that UHC needs five years, your doctor will appeal this for you, it's not over yet, hang in there!!!

Thanks, yes. I can show graphs of my weight prior to 2008 when i started nonsurg weightloss. Then I can show the nicely sloping graphs when i was working with the doc, and the spikes that shoot up higher than the starting point when i stopped working with the doc. And yes, i have diabetes as a comorbidity and have been on metformin since 2008. Hoping I can appeal successfully. Not the way I wanted to start 2013, but iam not that surprised, either.

Can someone tell me how this appeals process works? I know nothing about this. Thanks!

Before I got approval I was told by the drs. office that I should not be surprised if it is denied the first time. That's just how the insurance companies work. I was fortunate in that it was not, but that being said, you should submit the information again in hopes that it is approved on the second go around. Don't give up!!

 

Well..that stinks BUT don't give up. I have UHC and I used Dr. Hart at Atlanta Bariatrics. I was told by UHC that I had I have to have a letter from my primary physician stating I need the surgery and that he would release me for it, and a BMI of 40 for at least 5 years. My husband's place of business had this particular plan with UHC! I did have the BMI of 40 except for one year for a short period of time where it dipped below that because I went on a diet. But I gained it back!

My primary doctor gave me the letter but he didn't really like it but I had the BMI, HBPressure, and was staring diabetes in the face. Then, I went to my OB/GYN and got a copy of my chart going back 5 to 6 years to get my weights. I was able to take ALL my weights and put them together on a chart and my doctor had it typed up on his letterhead and signed it (after all the weights and dates were confirmed.) I was extremely worried because my doctors office OB/GYN that had ALL the weights had put the wrong dang height on my chart which screwed up my BMI. They refused to correct it. But my primary doctor had the correct height but not all the weights. So I used the OB/GYN weights and the other doctors letter and it all worked out. I was SO nervous! 

They told me at Dr Hart's office to not worry and they would handle it. The patient mediator told me that if the doctor is convinced you need it they will call UHC and go to bat for you. They will call the doctor at UHC and talk about the what's and why's you need it. I think they call it a peer meeting? They do it ALL the time. And usually after that the insurance will pay after the doctor talks to them. If you have the weights, and why the BMI dipped down below 40 and co morbidities you should be fine. I used to say...I can't believe that they would say I am NOT fat enough. GEEZ!! 

Good luck! And Go Dr. Johnson! Hope it all works out for you! It was the best decision I have ever made. It has already changed my life for the better!

Amy  

Many are denied on the first try.  There are many avenues for appeal.  It's frustrating and time consuming, but don't give up.  Hope you get that approval soon! :)

I was also denied due to this. I was actually denied twice. Third time it went peer to peer which meant my doctor fought with my insurance and I got approved. My surgery is a week from Friday! Please don't lose hope. I'm proof you can beat it! Also, I have no comorb.

i now how you feel, i got denied 3 1/2 weeks ago. it is frustrating and its for something ridiculous. and my life is literally at a stand still. i cant get a job because i don't know where the appeal is or if the doc has done it yet and i'm not going to get a job for a few weeks and then quit. if it gets approved then i'm moving back to co in a couple months, if it doesn't get approved then i have to start the 6 months over again and ill just get a job where i am for the next 6 months. and i have put off school this year because i thought i was having surgery. so there goes a year of college i could be doing. it been 9 months since my last quarter of school ended. so i been home the whole time.(there was my wedding and visits to co a couple times) and i have a  couple friends but one goes to school an hour away only back on weekend and the other works 40hrs a week only having Saturday afternoon off and Sunday. and we just getting financially stable from the wedding. so i haven't been able to do much..... i was denied for having a nurse practitioner not a physician.   

sorry for the rant. but you get my point. i'm the same boat with you and its annoying and frustrating