Just Denied by UHC

Thin4Anisha · 06-11-2008, 11:10 AM

Surgeons office just called, UHC denied me.

My policy states you must have a 5 year history with a BMI of 40 or above. 4 years ago I went on phentermine and lost 65 pds. Because of the I was denied. Never thought I would be punished for trying to get healthy.

Any suggestions on what to do? Is it worth appealing?

Flowerpurr · 06-11-2008, 11:50 AM

Of course it's worth appealing. They are just trying to get out of paying for it. Tell them why your weight went down. Do you have any documentation of taking the pills? Did you see any other Dr.'s that year? Don't give up!!!! That is what they want you to do so they don't have to pay. If you need an appeal letter let me know and I can send you a three page one. My email address is Tazz7722@aol.com. If you would like the copy. Good luck! Don't give up and fight, fight, fight!!!

Jennifer S. · 06-11-2008, 12:00 PM

Don't even get me started on UHC!!!!!

I started my process in August '07 & did everything they required of me and when I finished everything and my surgeon sumbitted all tests and final approval they CHANGED what they required of me -- including now tacking on a 6 month supervised diet & I could ONLY go to what they called "a United Health Care center for excellence" -- which meant that even if I chose a doctor/hospital in network they didn't care because I needed to go to a hospital/doctor that took their extra classes and certification! A bunch of BS!

I ended up paying for my lap band but I am in the process of fighting them!

Good luck!

tcbeau · 06-11-2008, 12:04 PM

I was also denied by UHC due to no comorbities and a bmi of 38.5. I appealed with my PCP putting me on meds to lower my cholesterol. I am still waiting for a letter three weeks later, they sure take their time. I agree they want you to give up, so DON'T!!!!!! If you have any comorbities it is the best way to go, high choles., diabetes, high blood pressure, or sleep apnea with meds can help with approval so my doctor says, we will see?!? Keep trying, we are all praying for you!!!!

2thebeach · 06-11-2008, 12:50 PM

i have the same story as you and alot of others here. i gave UHC everything they said they wanted and then some... letters from 7 doctors and an attorney that was heloing me with the appeal process- so-- they changed what they required, and i gave them that, then they changed again! i beliece that whatever i gave them would not be enough ever! and my policy states it is a covered service! what a waste of time and emotional energy all that was- surgeryloans.com saved me-- i got my band last august and have lost 50 lbs and have 50 more to lose. i make a monthly pmt and its the best money i ever spent! good luck dear dont give up on getting the band :)

Jennifer S. · 06-11-2008, 10:25 PM

How sad! What about going through the Insurance Commission? Can they help with any appeals and/or consumer rights that have obviously been wronged by UHC? It sounds like they are doing this to everyone!

amsderb · 06-12-2008, 12:40 AM

Ok, not to be a voice of the other side...but I have UHC and it all went fine for me...I DO have the comorbid. and a high BMI...Showed the 5 year history thing etc....but I had no problems with them? I hope it gets better for you all.

mnm8077 · 06-12-2008, 08:30 PM

I just got approved by UHC today, I have no comorbities, but my bmi is 45. I had to show a 5 yr. weight history. Although it did take a few weeks for them to even get my info from my dr.
My dr. office faxed the info to uhc four times, finally Monday they recieved it and approved me today.

Jennifer S. · 06-12-2008, 09:47 PM

Good for those that got approved....BUT...

Any thoughts for those of us who showed UHC what they wanted and denied us?

Was it ever mentioned to those that got approved (and those that didn't) this having to have your surgery by a "UHC center of excellence/doctor of excellence"? I had my surgery done at one of the top 100 hospitals in the country and just because they won't pay UHC to take their extra tests that hospital is out!!!!!!!!

amsderb · 06-12-2008, 10:27 PM

Was it ever mentioned to those that got approved (and those that didn't) this having to have your surgery by a "UHC center of excellence/doctor of excellence"?

My employer has an addendum or something like that...it had the criteria that I had to have been employed for 5 years by them, I have been there 24!...

.

My BMI had to be over 40 or 35 with comorbidities...

Also, that it had to be performed at the center of excellence...which LUCKY for me...My doc is and is a preferred physician etc..

.

So, yes I guess it is that way....keep fighting and switch docs if need be..

OOPS, I see you were banded..self pay? .I really found UHC to be pretty easy to work with...my employer is the one that had the specifics????

Good Luck

Cherylita · 06-12-2008, 10:58 PM

Hiya! I have UHC too but not sure I will be covered because all my bloodwork is fine. I have low blood sugar, low cholesterol pretty much low normal on everything! My BMI is @ 65 though. I would hope that counts for something. Also, I don't know if they Drs will have accessible records from 5yrs ago. So Im a little worried. I read these folks problems and now am a little more worried. I am glad things went well for you and thanks for the positive thoughts! I am crossing my fingers that they will go just as well for me:) Thanks again!

Cherylita · 06-12-2008, 11:02 PM

WOOOHOOO!!MNM! So glad to hear you were approved! How exciting!!

**MacMadame** · 06-12-2008, 11:13 PM

Quote:

Originally Posted by Jennifer S.

Was it ever mentioned to those that got approved (and those that didn't) this having to have your surgery by a "UHC center of excellence/doctor of excellence"?

That's a pretty common requirement, actually.

It's funny how these things go in cycles. A few weeks ago it seems like everyone who had UHC was getting approved just like that, no 6 month diet, no 5 year weight history. Now it seems like no one is getting approved.

I was just about to switch to UHC too. My company is in open enrollment right now.

Futr littl Debi · 06-17-2008, 08:07 PM

Hi -
About the Centers of Excellence requirement...that is a designation that the doctor / hospital program gets from an outside entity. It isn't an extra class provided by the insurance company. My insurance company has that requirement too.