WorriedDaughter99

My mother is in desperate need of a weight loss surgery. She is 52 years old. She has had diabetes for 27 years. She has to take insulin for every carbohydrate she eats and takes one every morning and night on top of that. She has that regulated now. She has kidney problems. She has "gout" (don't know how to spell) it is a very bad type of arthritis all through her body. She has high blood pressure, back problems, etc. She can no longer get around by herself, she has gained 100 lbs in less than a year because she is unable to even go to the bathroom by herself. She had a bowel rupture in December that just about killed her. Her doctor sent in a form to get her approved for the LAP BAND due to her size (450 lbs) and her health condition and United Healthcare refused her! Her visit in December cost almost $200,000, so why would the insurance company not want to do this surgery?
Where can we go from here, any ideas?!?!?!

jillagin2000

Appeal the decision in writing. You have 180 days to appeal and UHC is counting on the fact that most patients aren't aware of the appeals process or just plain don't think it'll be successful.

Jeanie

Yes I would appeal also. I had to appeal twice before I was approved for GBS. My doc said that half the people don't appeal, and that is why a lot of people are denied the 1st time around.

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Lap Dr. Callery
July 7, 2004
Savanna Annmarie was born on 10/14/2008

imwiththeband

It seems as though with the "co-morbidities" your Mom is suffering (High BP, arthritis, etc.), she should have no problem getting approved. I have Blue Cross HMO and got approved right away b/c of High BP, joint pain. In my case, my primary care physician's office had to approve. If it is getting stuck there in the process, perhaps you can contact the Bariatric Surgeon's office and find out which Primary Care docs refer to them...then switch your Mom's primary. Even if she likes her doctor, getting her back to good health is more important. Good luck!

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Lap Band 4/1/08 - San Diego, CA
(69# lost since first consult 1/29/08) Onederland 8/10/08!