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Got denied by UHC and I'm Angry!


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Paul everything I'm reading online on forums says choice plus doesn't require the six months. Sounds like someone at UHC dropped the ball.

I gave choice plus and there's no requirements at all. Just the bmi over 40 or two issues if less than 40
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I had to do a 6-month diet profile plus my Bypass Dr made me lose extra weight before he would do my surgery:) Just keep trying and don't give up:)

I have not been denied yet, but my insurance company, UHC, has asked for a 5 year weight history of which I only have 3 (I didn't have insurance for a few years so no doctor appointments). I did alrea

I am so very sorry to hear you were denied...I have UHC as well.  What I would recommend is to contact UHC and get a copy of the guidelines according to your group.  Having a clear understanding of th

I had to do a 6 month doctor followed diet. Which basically was just going to my pcp once a month she'd ask if i was following my diet then weigh me and chart it. It was very annoying because it cost me an extra $30 a month for that but after 6 months i met with my surgeon and did all they asked and my ins approved my surgery. all in all it took about 9 months from start to finish. So don't give up and keep trying. Good Luck!!

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I wouldn't think they would need your book. Like I said before, I just wrote down all the diets I have tried over the years and that was it. I just got approved this week by UHC. I think your doctor insurance person who works with the insurance company should know exactly what would be needed. Its not like UHC is a small company. Don't give up!

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So sorry...I have been having the lower back pain, hip, knee. Went to Chrio too did nothing. Yes, I hope you get something to make you more comfortable. And YES the whole process can be stressful, I found it didn't help me at all but it seems to consume our lives. Take Care!

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UHC Choice Plus.. I have UHCCP and they will not cover the surgery as my employer did not add a "obesity" rider to the policy. So even if you have this insurance, it might not be covered. Check your benefits online on the UGH website.

I also have BCBS as a secondary policy and they don't cover it either. Ugh! So I'm out of pocket for the 22.5k

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UHC Choice Plus.. I have UHCCP and they will not cover the surgery as my employer did not add a "obesity" rider to the policy. So even if you have this insurance, it might not be covered. Check your benefits online on the UGH website.

I also have BCBS as a secondary policy and they don't cover it either. Ugh! So I'm out of pocket for the 22.5k

that's unfortunate...but mine is covered...

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that's unfortunate...but mine is covered...

yeah, thers about 6 people at wor that have went and got it done. All of them ttold me it was covered then my surgeon confirmed that as well for UHC Choice Plus. Jlewis sorry to hear that man. But in all honesty I dont think I would let that stop me if I knew I could afford the surgery.
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I'm lucky too, mine is covered also and I also know several people who have had surgery. That's the bad thing about UHC when you call, you can get different answers but my doctor also knew my plan covered the surgery.

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  • 2 weeks later...

I also have UNC and was told all I needed was a five year history. Am just starting the processes, should be interesting. I have my first consult this Friday. Nervous and excited, but not going to get hopes up.

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Some insurances make you go through a 3 month or 6 month supervised diet plan. I had a relative that had to wait 6 months and she checked in with her surgeon every two weeks for 6 months and that was considered a supervised diet. Luckly Blue Cross Blue Sheild dropped their wait period in Feb and I did not have to go through this. I know how frustrating it can be when you finally decide to go through with the surgery and then be told you have to wait another 6 months before you can even submit your claim. Good luck and the 6 months really will go by faster than you think.

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Have you ever been on diet pills or talked to a nutritionist? I had over years before being diagnosed with pcos and other problems. My doctor was able to get that stuff from my old doctors. But I had different insurance than you but it covered my diet stuff and trying period

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  • 4 weeks later...

I had to do a 6-month diet profile plus my Bypass

Dr made me lose extra weight before he would do my surgery:)

Just keep trying and don't give up:)

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  • 2 weeks later...

I had to wait 6 months also...only because I had no receipts proving I was trying to lose weight...My 6 months is up in March,and I've been up and down with my weight! It's been difficult with the holidays to lose weight...:( Hoping I don't get tuened down if I don't lose whatever amount they think I should lose? Which I was never told...:/ 

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  • 2 months later...

I have not been denied yet, but my insurance company, UHC, has asked for a 5 year weight history of which I only have 3 (I didn't have insurance for a few years so no doctor appointments). I did already do a 6 month supervised diet, so I'm hoping something can be worked out on the 5 year history because I really don't want to have to wait 2 years.

 

**Edit: Seems my doctor was being overly cautious, I just got my approval without the 5 years.

Edited by derkkila
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I was told I had to have a 5 year history by the same hospital (Scottsdale Bariatric) but the weights I provided on my initial intake was plenty to prove my weight issues.  I haven't had to give them any medical paperwork to "prove" my 5 years.  I also have UHC, but mine is due to being a State Employee, so I don't know if that makes a difference....

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I have UHC.  I was afraid of being denied because 10 years ago I had the lapband done - also covered by UHC.  Their policy is once per lifetime for bariatric surgery.  Since 2003, I developed severe acid reflux, my esophagus became tortuous (developed twists in it instead of being a straight line) and was once diagnosed with Barrett's esophagus.  I gained almost all of the lost weight back due to a severe bout of depression.

 

I've since gone on anti-depressants, and consulted with another bariatric surgeon.  She wrote a letter on my behalf telling UHC I desperately needed a revision surgery to gastric bypass.

 

The insurance company also requested 5 years worth of medical records showing my documented weight from my doctor's office.  They did not ask for any documentation of previous diets.  I don't remember them asking when I had the lapband either. 

 

Luckily, the insurance approved the revision and I am now about 10 weeks out.  Lost 30 pounds. 

 

I would definitely appeal and ask your surgeon to write a letter to the insurance company telling them of any co-morbidities related to your condition.  I hope you get approval. 

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Most insurance companies like a supervised diet of so many months. It is frustrating- I had to do six months and glad i did because I learned tons and did lots of research prior to surgery. I would call up a dietitian and start as soon as possible while they work on resubmitting your paperwork and or you fighting what they said. It helps to have dr's notes of xx amount of years of weight issues and if you have any other medical issues due to weight. Hang in there.

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I also got denied because of the 6 month diet (I have UMR).  I sent in my appeal letter last week stating that I had talked to 3 different customer service reps (one of them a senior customer rep) and all of them told me the same thing that I didn't need it.  It's not our fault when they can't tell you what you need and I also believe that it should be in their insurance book that you get at your company, mine said nothing (I read it 3 time cover to cover).  I now have to sit and keep my fingers crossed.

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