[Exhorter]

Hello Everyone,

It's me Exhorter (Dona)
Well I got my second denial for my surgery. I found out yesterday the REAL REASON why they are saying no. It's seem that although my husbands company does not have an exclusion in their policy against obesity surgery, they do have just a couple of lets say "POLICIES that must be MET before they will allow it to happen, and I just finally found out after 8 months and two appeals. I checked several times with UHC to make sure there were NO EXCLUSIONS as did my surgeons office. But it's not an official exclusion...... Just a policy they forget to find while checking on my benefits for 8 months and nobody could find it until they sent it in for review and even in the denial letter nobody could tell me why. So it finally hit me that there was something in the denial letter about the members handbook and check on page 20!!!!dughhhhh
But still UHC could not tell me anything my surgeon could not tell me anything so I got ticked and called my husband coporate office and there it was clear as day!!! BINGO!!! JACK POT!!! and here it is

The benefit document covers surgical treatment of morbid obesity when the patient has documented morbid obesity for at least 5 years, has documentations of having failed at least 3 years of physician supervised non-surgical weight reduction treatment, and has a co-mobidity (e.g.. Heart, lung blood vessel or endocrine disease) that indicates a need for surgery (see the benefit document). (this means the document that my husband never got or even knew about when he started the job)

So the only one that I could prove and the only one that United Health Care approved was the fact I have met the 5 year morbid obesity. I at this time have no 3 years of physician SUPERVISED weight reduction treatment, and as of right now no real health such as I am not about to die!! (Although weighing 200lbs over my weight I could kick the bucket at anytime but not enough for them.)
Cause to meet those requirement of being treated supervised for 3 yrs by a doctor for being fat would mean I would be very very sick probably to sick to be able to have the surgery. So at this point I have no clue what to do.

My surgeons office wants me to go to one of their doc for a COMPLETE Medical History Check up and testing with blood work. It has been since 2002 that I have had a check up and I weigh 125 lbs more now so things have changed. They think that if they can get enough doctors to say I need this surgery then it might get them to over turn the "POLICY) but it is not United Health Care it is my husband company with the request.

But there is no way for me to come up with that 3 year history of medical supervised weight reduction treatment. AND THEY KNOW THIS!!!

So now I wait and they say they will submit one more appeal and it will be denied as well they said and then they said the doctors will step in. So all I can do is wait and see if these doctors have any pull.

I am thinking about buying the buy here on the board but I am not sure if it is not really to late for that?? Things seem to be out of my hands at this point and time. Also I do have a dr appointment (GYN) to get the results of my ultrasound so it will be intresting to see what they have to say since I was to fat back 9 yrs ago for them to take care of the problems and now I am at least 50 lbs fatter.

Can you tell I am down LOL I truely felt this was my last hope of ever getting this weight off and it does not look good right now. I just do not know what I am going to do. I am almost to the point of being home bound and I am afraid that if something does not happen either I will be dead in 10 years of weight over 500 lbs.

[mike]

You need a hug exhorter. Insurance companies do suck don't they? I can only imagine the hurt and rejection you must feel right now. I had a cousin that basically had the same thing happen to him....denial after denial. He almost gave up...literally. He, as you have mentioned, got enough doctors to reccommend that she have the surgery, and she did....eventually. It did take over two years, but he did say it was well worth the wait. HANG IN THERE KIDDO! Your day will come for you to. Keep posting as often as you need to. We are all here for you in any way that we can be.
mike

[MsVickie]

Dona honey you know my advise on this one. Do as they ask. That is the hardest part but that is your only resource now. I agee with Mike in your needing the hug. Im here if you need me OK?

[fr1endly2]

WOW that blows Dona!!!!
THERE just putting such butt covering
stuff in these policies.
I know you would cost the insurance
company less money as a healthy non
obesite person then paying for this surgery.
I am sorry this going on for you.
ITS frustrating big time.

((((HUG))))) i am not sure what to even say.

[armywife2aerial]

o man I am so sorry this is all happening to you. keep fighting them when I read this post it scares me because we have united health care. but i beleave it is a different plan. but still i am so sorry this is happening to you. I'm going to keep you in my thoughts and prayers.

? when you called and ask the criteria for bariatric surgery they never told you that ? that is BS how are you in the rong if after every time you called you were never informed.

I STRONGLY DISLIKE INSURANCE COMPANYS

[bren]

All I can say is I'm very sorry and offer you a (((HUG))) it sucks that insurance companies have to be like that!

[Kenyar]

Dona,
I have to say this. If this is your decision and is what you truly want, then please get started on the documentation. It might be "easier said than done" but if this is truly what you want please do not give up.

you are in my thoughts and prayers. stay strong.

[whizzersmom]

Dona, I agree totally with Kenyar, DON'T GIVE UP!!!!! PLEASE DON'T GIVE UP!!!! I know insurance co. just don't seem to care. They talk out both sides of their mouths. They preach be healthy, loose weight but then they won't cover anything that has to do with nutrition or weight loss. At least that is how my ins. co. I have right now is. I have Keystone but I am switching to Cap b/c in March. I hope and pray everything works out for you. Keep us posted and we will be here for you if you need us!!

[DocSanae]

Awww, ((((((((HUGS))))))))
Donna, how many times have you been to see your dr in the past 3 years? Have you been weighed with each visit, been told something or other about controling your weight, or been given an advice or two about yoru diet? In other words, does your dr have in his/her records of being concerned about your weight, and giving you some sort of instruction or another? If there is, I think it's worth a try to work with that dr to have it formulated/translated into a medically supervised effort, even if it wasn't as clear and as precise as most people relate to as being a supervised program.

As everyone says, just don't give up, keep on fighting, we're all behind you 100%!!

[Exhorter]

Well Doc see that has been the problem for over a good 10 years at least. I had no insurance and so I would have to go to this big hospital to always see the dr. It was always usually about female problems. However at least 50% of the time when I would go into the clinic they would say something about my weight. Even could not have a surgery I needed to control the felmale bleeding due to my size they did not want to put me under. The problem with all of the medical records is that most of the time they did not say anything in their records about me us discussing my weight.

Also I want to again stress it is not United Health that is the problem here it is my husbands employer and their policy that I must meet. It is not an exclusion saying they will not pay... but I must meet their HARD list of request before they will even consider to pay. So those waiting for United Health Care to cover you it's not about them in my case.

Thanks everyone I will just keep fighting until there is nothing left to fight about.