 Ins. coverage denied a week before surgery:( Not sure what to do next.
I was supposed to have gastric bypass surgery tomorrow, but I was abruptly informed last Monday by the surgeon's office that my insurance (UHC) denied coverage for my surgery. This was a week before surgery, I had already had my pre-op at the hospital, everything was ready. I'm devastated and not sure what to do next.
The coverage was denied because I haven't been morbidly obese for at least 5 years, a policy we weren't made aware of until that day. We are going to try to appeal it based on medical necessity, but it could take months and there's no guarantee. We are still waiting to receive the letter stating why it was denied and what they needed if we were to appeal it.
I’m not sure whose fault it is about not being informed about the policy. When I called United Healthcare before things started rolling, the agent I talked to did not mention this policy, only that a five year medical history was required. The surgeon’s office, who have all been great and very helpful, did not mention anything either even though they’ve done this countless times. We read the 100+ pages of my insurance plan and found the policy in small print, so I guess that we learned the hard lesson of not relying on other people for the requirements.
I've rapidly gained the weight (and continue to rapidly gain it now) because of a severe case of mono I had exactly five years ago that I have had complication from ever since, namely severe fatigue, which has turned into idiopathic hypersomnia. When I got the mono five years ago I weighed around 140 lbs. I do not have any of the major co-morbidities yet (diabetes, severe sleep apnea, etc.), but I do have:
+Chronic severe pain in neck and shoulders
+Severe excessive daytime sleepiness (Idiopathic hypersomnia) —I’ve had two sleep studies and dozens of other tests and they cannot come up with an explanation for the cause
+Major depressive disorder—which had been stable for awhile until the news that I wouldn’t be having the surgery, now it’s probably the worst I’ve had it
+Other aches/pains including swollen feet
These health issues were all jumbled into my medical records that were sent to my insurance, but if they were further expounded upon/highlighted by a doctor, would that help?
I feel trapped, because I do not have enough energy to do a lot things, including exercise. When I do get out and exercise, it wipes me out completely for the rest of the day. I do not eat especially horribly (I could always improve), but with no activity, I continue to gain weight.
I was wondering if anyone has any advice or experience they would be willing to share. Thank you so much for reading this far.
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