Discouraged

I called UHC last year and the surgery was covered with a BMI between 35-40 with 1 comorbidity - no diet required, no nutritionist required, no psych eval - just five years of being severely obese. So I waited until the start of the new year and went to the doc who says I'm the perfect candidate. I call my insurance today to ask them my list of questions and BAM!! I'm told that you have to have a BMI of 40 or above with 5 year history of being morbidly obese (not just severely) and there is no comorbidity exception for lower BMI's. So am I screwed? Is there no way to get it covered? And if not - does anyone know of a place where a person with horrible credit can get a loan to pay for this?!!

Urghh - I'm just so frustrated. I thought I had this in the bag and then to have the rug pulled out from under me like that just sucks!

Did they recently change their policy or something? Do have any copies of the policy you had been given or told before?

I am right on the edge of qualifying for my insurance...it could really go either way. Yes, it scares me that I might go through hoops and emotional upheaval for nothing, but in the end I can't say I didn't try. And who knows? Maybe it will go through.

I would still go ahead with your decision to pursue the Lap Band, if that's what you truly want. The worst they can say is no, right? And if that's the case at least you're no worse off than you are now. Yeah, it would suck, but at least you tried. Then of course there are always appeals and such. I've read several instances here where a person was intially denied but then they were approved through an appeal.

Don't get discouraged, you don't have a rejection letter in-hand so you still have a chance! I say go for it!

Thanks for the encouragement! That's really what I started thinking - I mean what else am I going to be doing for the next three months of my life? I'm planning on just staying the course, doing everything the surgeon wants me to do, and then just seeing what they say. I've also contacted my HR department to see if maybe it's just an oversight...it's possible! My company did a complete overhaul of their benefits for 2008, but I really don't think they were changing coverage, they were just changing deductibles. Anyway, I'm keeping my fingers crossed!

I have UHC and I had to gain a *couple* of pounds to put me over the edge of 40 BMI. It was worth it. I had my approval in 3 weeks.

Congratulations on getting the surgery! I have actually thought about doing that, but it would be 20 pounds in my case and then it still says you have to have 5 years of being MORBIDLY obese. I think morbidly means a BMI over 40, so I still woudn't qualify. I'm just still reeling from the fact that four weeks ago diabetes and a BMI of 35 would have been enough and now it's not covered!

And the worst part is that I had a freaking appointment in mid-December but didn't end up going because of all the Christmas stuff!

I have UHC and was able to go back and find numbers in regards to weight. My wife and I were approved with in 30 days. If you would like e-mail your e-mail address and I will forward you a copy of the letter we used and got approved by UHC. DO not give up. Were here to help you out.

Chris

Insurance carriers are really looking at obesity as a chronic disease and they are covering these surgeries more often because the statistics show that obesity lead to other illnesses. I would appeal the decision especially if you have other chroninc illnesses such as diabetes, high blood pressure, etc. Do not take no for an answer this is election year and the ins. carries do not want publicity especially UHC because they were just fined millions of dollars for not paying claims properly.

UHC just wanted me to show 5 years of failed diets, not 5 years of being morbidly obese. I go to the OB once a year so I had majority fluctuating weights to show.

Thanks so much for all your replies. I feel a lot better about the situation now. If this doctor that I went to recently doesn't want to pursue it, I will just have to find another doctor who is willing to help me fight. I'm in Houston so there are a LOT of doctors to choose from!

Thanks again for all the encouragement!

I just wanted to give y'all an update because I am so happy I can barely contain myself. I have been going back and forth with my HR department trying to get them to drop the BMI requirement back down since it was covered last year and they have just sent me an email telling me that they are going to update UHC's system to reflect the fact that WLS is a covered benefit with a BMI between 35-40 with one co-morbidity!!!!!!!! So happy I can't take it!

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