Guest guest Posted February 21, 2004 Report Share Posted February 21, 2004 Felicia I also have UHC. Co-workers of mine, all w/BMI over 50, were also denied on first request. It seems to be routine. You may want to call the member 800 number on the back of your card and ask for Care Coordination. They are the ones who approve/deny requests. I had a good experience talking to them. They DO need letters of medical necessity. Im glad I called ahead. I listed all my co-morbidities (diabetes, hypertension, sleep apnea, high cholesterol, acid reflux, joint pain from back and knee surgeries, stress incontinence, plantar fasciatis, varicose veins); listed all the rx meds I hoped the surgery would eliminate (insulin, glucotrol xl, glucophage, cozaar, lasix, potassium, lipitor, celebrex, nexium, raniditine) and the hopes of reducing my risk for stroke, heart attack, blindness, renal failure and other diabetes related disorders; adding expected resulting benefits (endurance, pain reduction, appearance, self image, overall better health). My BMI was only 37 and I was approved in a record 48 hours. The more you can lay on them, the more you show you want this surgery for health reasons and not cosmetic reasons. This will also help your surgeon's staff present a complete case to UHC for you. UHC also wants to see a history of previous diet attempts. Put on your thinking cap and go way back. Dont omit anything. I began with 'remember metracal in cans in the late 1960s-early 1970s.' I listed every attempt at weight watchers with approx dates, if only the approx year. I listed every time I talked a doc into diet pills, every time I tried to lose weight. If you or anyone wants to see my attachments, email me off the list and I will be glad to send them to you. Anything to help. Now, on the downside, I read an article in the Palm Beach Post 2 weeks ago that said UHC, Humana, Centra all discontinued coverage for gastric bypass and that Blue Cross Blue Shield of Florida would discontinue in January 2005, and that Aetna was the only insurance company still approving coverage. The link in the paper was only good for 7 days without paying for an archived article, but I saved it. Again, anyone interested can email me off the list. The reasons were purely economical. I only hope they dont become liable for risks involved from not having the surgery. On a side note, I found and saved a link for future use. It is a compilation of appeal letters to insurance companies covering everything from the WLS to plastic surgery. http://mygastricbypass.com/appeals.htm I hope this helps you or others. Do not give up; but do not go in unprepared. Be Well ~~Pat~~ 252/209/160 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2004 Report Share Posted February 21, 2004 Felicia I also have UHC. Co-workers of mine, all w/BMI over 50, were also denied on first request. It seems to be routine. You may want to call the member 800 number on the back of your card and ask for Care Coordination. They are the ones who approve/deny requests. I had a good experience talking to them. They DO need letters of medical necessity. Im glad I called ahead. I listed all my co-morbidities (diabetes, hypertension, sleep apnea, high cholesterol, acid reflux, joint pain from back and knee surgeries, stress incontinence, plantar fasciatis, varicose veins); listed all the rx meds I hoped the surgery would eliminate (insulin, glucotrol xl, glucophage, cozaar, lasix, potassium, lipitor, celebrex, nexium, raniditine) and the hopes of reducing my risk for stroke, heart attack, blindness, renal failure and other diabetes related disorders; adding expected resulting benefits (endurance, pain reduction, appearance, self image, overall better health). My BMI was only 37 and I was approved in a record 48 hours. The more you can lay on them, the more you show you want this surgery for health reasons and not cosmetic reasons. This will also help your surgeon's staff present a complete case to UHC for you. UHC also wants to see a history of previous diet attempts. Put on your thinking cap and go way back. Dont omit anything. I began with 'remember metracal in cans in the late 1960s-early 1970s.' I listed every attempt at weight watchers with approx dates, if only the approx year. I listed every time I talked a doc into diet pills, every time I tried to lose weight. If you or anyone wants to see my attachments, email me off the list and I will be glad to send them to you. Anything to help. Now, on the downside, I read an article in the Palm Beach Post 2 weeks ago that said UHC, Humana, Centra all discontinued coverage for gastric bypass and that Blue Cross Blue Shield of Florida would discontinue in January 2005, and that Aetna was the only insurance company still approving coverage. The link in the paper was only good for 7 days without paying for an archived article, but I saved it. Again, anyone interested can email me off the list. The reasons were purely economical. I only hope they dont become liable for risks involved from not having the surgery. On a side note, I found and saved a link for future use. It is a compilation of appeal letters to insurance companies covering everything from the WLS to plastic surgery. http://mygastricbypass.com/appeals.htm I hope this helps you or others. Do not give up; but do not go in unprepared. Be Well ~~Pat~~ 252/209/160 Quote Link to comment Share on other sites More sharing options...
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