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