Denied

Mrs Sabre · 04-17-2006, 04:51 PM

I finally got an answer from UHC. According to UHC my average BMI falls within 35-40, but my co-morbidities are insufficient. Approval has been denied. I imagine Dr. V will appeal? I'll ask Kim and let you know.

Dragonwillow · 04-17-2006, 05:07 PM

Oh Karen, so sorry to hear that. Hey maybe you can follow my current diet plan. You are sure to gain enough to be qualified then! ...JUST KIDDING...I've gained like 3lbs this month instead of loosing. I don't get it...I dont' need a feel, if anything I get stuck MORE often. I'm not eating crap...well at least not all the time. I am drinking with meals which stops now.

What are you co morbids? Could they have overlooked something that should be documented? What about all the leg pain and stuff you have been having, can that be related to excess weight?

Melissa

Mrs Sabre · 04-17-2006, 05:13 PM

I have hypothyroidism, restless leg syndrome with periodic limb movement disorder, mild-moderate sleep apnea (but not bad enough for a CPAP), depression, mild stress incontinence (embarrassing to admit). I now have a pinched nerve in my lower back, which is made worse by my weight.

I don't have high blood pressure or diabetes, or those more "serious" co-morbidites but had hoped that the numberous less serious ones added together might be enough for approval?

3loves · 04-17-2006, 08:06 PM

Oh Karen ~ I am so sorry to hear this. :phanvan I may be joining you soon as I have a feeling my insurance is looking for every reason under the sun to deny me.....my file is currently being reviewed by the insurance physician and has come back once requesting more info.

Something I have learned through all of this though is that the appeal usually takes a lot less time than the initial submission. Do you have a family history of any co-morbidities that could be considered a risk down the road?

Here's a couple of sites I put in my favorites (recommended here at LBT) in the event I need them. I don't know how you intend to proceed, but maybe these links will be of some help.

http://www.obesitylaw.com/

http://info.insure.com/health/claimdenial.html

I will continue to pray for you and remember the Lord's timing is perfect. This isn't over so keep you chin up!!!

JAYGERL05 · 04-17-2006, 08:54 PM

I had UHC as well with a bmi of 40 no comorbidities. I did have several family members with problems and obesity which could possibly be me in the future. I was approved in 9 days. Best of luck, appeal appeal and appeal again.

Mrs Sabre · 04-18-2006, 06:06 AM

Bless you all for the words of encouragement! My Mom and Dad are both overweight (although not as much as I am). Both parents have high blood pressure. My Mom's cholesterol is over 400 without medication. My Dad has non-insulin dependent diabetes. My brothers are both lean and healthy so far.

As of Thursday last week, I have a diagnosed pinched nerve in my lower back to add to my list. I'm sure my weight doesn't help it any, and the resulting pain is making it impossible to exercise.

After a long 8 months, it's really hard to continue to be patient, but I am going to appeal.

**gordonfamily3** · 04-18-2006, 06:10 AM

Karen - let me get to work and read the info I have on UHC. Maybe there is something there that will help get it through. If not let me know what you want me to do to appeal. There is some law in NC that if it's medically needed they can only turn you down 3 times before they have to cover it. Steffney was telling me about it.

Hang in there girl...you are so right there is no need to be patient now, after waiting for one doctor just to get in at another and not to be denied girl you need to move full steam ahead and I will be there with you.

Denika · 04-18-2006, 10:44 AM

Karen,
That just really stinks! But, please don't give up, and APPEAL as many times as it takes. We are all here for you through this, and this WILL work out. I'll be praying for you too!
Denika

kim2bhealthy · 04-18-2006, 10:56 AM

Karen- so sorry to hear that you were denied... Are you going to appeal? I can definitely relate, I've been denied twice and just submitted my second appeal to the Ins Co. and to my state Department of Commerce and Insurance. Is self-pay an option for you? That's what I'll probably end up doing.. I hope it works out for you! You should appeal at least once, and really bombard them with information. I sent a package about an inch think in for my appeal... Let me know if I can help with what you need to include... The appeals department at my ins. co. even complimented on what an impressive, actually I think she said "beautiful" appeal package that I submitted. Unfortunatley, I am trying to fight an exclusion... Good luck, and keep us posted!

**gordonfamily3** · 04-18-2006, 06:20 PM

Karen I can't tell you this enough...please let me know if there anything I can do for you. I will let you know what I find out tomorrow @ my seminar.

I am here for you at any time!!!!! Don't hesitate to call me!!!!

the best me · 04-18-2006, 10:22 PM

Karen, I'm so sorry this is such a frustrating battle. I just almost feel guilty having my band! Girl, you have GOT to get through this. Don't give up. Get all the help you can with this, don't lie down and take it. Find your gumption, your steam, your WILL and keep at it! Please!!!!! I don't know what to do or say to help, but I'm sending prayers and big (((((HUGS))))) to help you along.

Mrs Sabre · 04-19-2006, 06:21 AM

I'm typing an appeals letters as we speak and will fax it to them today. Kim, I'll fax a copy over to Dr. V's office too. I'm going to ask that they look beyond their predetermined list of co-morbidities and consider my total health (past, present and future) and reconsider payments of benefits.

I don't see me going as far as getting a lawyer. If not approved after an appeal, I'll look into financing options. I'm not sure that John and I can swing it, but we'll see. If I have to finance, I may have to wait until John's truck is paid off in another year.

wavydaby · 04-19-2006, 10:32 AM

Im soo sorry. I was hoping that when the lady told you to call back later, that it was going to be good news. Maybe you can highlight anything about being depressed about the weight that and emphasize? Anything about affecting work habits/lifestyle?

LovelyLT · 04-19-2006, 12:26 PM

Karen - I'm so sorry they turned you down. Appeal away!! I had a BMI of 39-40 when my doctor first suggested WLS. By the time I turned in my paperwork my BMI was 41 - and by approval 43. Hang in there and keep the faith. Take care

Mrs Sabre · 04-19-2006, 01:56 PM

I faxed out the appeals letter early this afternoon. I may not have the specific co-morbidities they're looking for, but I was able to come up with 7 of my own for which weight loss would help if not cure the problem. Just listing them out, they don't sound like much. When you include the effects they have on your health and/or quality of life, they sound a lot more detrimental. I'm sincerely praying that UHC will look at the whole picture and see how much I need this!