Kerra

I am gutted I had my surgery back in April, and couldn't be happier. In fact, my husband is scheduled for surgery on Monday 7/30. Well, anyways, the center KNEW from the beginning that he did not have a 2 yr weight history, which is required by Aetna. They told him that they have ways around that one and not to worry. Got a denial letter two weeks back and was told "don't worry- surgeon will do a peer review and they very rarely deny them." this was all from the insurance coordinator at the center. He went in to sign preop forms today. He asked the surgeon if it was taken care of. He was shocked to hear this- said he was not notified by said insurance lady, and that he would have a word with her and get it done today. Well, afternoon rolls around and he gets a call from the insurance lady from the center. Peer review was a fail and she told him to start getting his weight documented and to come back and see them in two years!!!!! I am absolutely disgusted with how unprofessional she had been throughout his whole process. We are out about $1200 from co pays, deductibles, co insurance, time off from work, etc for him to be a part of the program. I am beyond pissed off- his leave was already submitted for work, etc. Who does the insurance coordinator think she is? Lying and then forgetting to mention to the surgeon of the issues? My question for you guys- anyone ever been denied from Aetna for not having a clinically documented weight history, proving obesity for two years? They will not accept his records from 2007&2008. Wondering if there truly is a way around it like we were told in the beginning? If so, what did you do? We have submitted an appeal directly with the insurance company as we feel we cannot be bothered with the insurance coordinator at the center any more. But that a) will take 30-45 days; will most likey be denied.

Thanks Sandra! You have given me a glimpse of hope that we my win this appeal!!

Sojourner- BMI is 40; no comorbities. He is rather healthy and has not see a doctor for years because of that. Wished he had at least gone for physicals every now and again. So today, I have set him up with a PCP that he will see tomorrow, hoping that she can write a letter. I also contacted his pediatrician to get his weight history from childhood and adolescence. Lastly, I was able to obtain his weigh ins from Slimming World (much like weight watchers) but they are unofficial so I am not sure they will do much of anything. But I thought I would include them along with the appeal. Hoping with all I have that this works.

Sandra07- when did you have surgery? Apparently Aetna updated their requirements this year.... Not sure when. We are still getting nowhere. Depressing.

I was just thinking- he did belong to weight watchers at one point- probably 2009/2010. Anyone know how he could get those records? I don't think he saved anything, unfortunately. I am more than gutted. He was not only psyched about getting the band, but also about getting his hiatal hernia fixed to help his GERD.

He has nothing. I did not encounter this with the same insurance as I had two years of documentation. We knew it was required, so ot was the first thing he told them before signing onto the program. Her exact words were not to worry about it, there are ways around it. Now he is being told to come back in two years by the same lady? Unacceptable.

Trying to get a feel for them- Anyone find one where you can track protein and not just calories? I was going to use Realize My Success but they are shutting the site down soon....

Are you still on liquids? My surgeon said between now and my fill I am pretty much on my own, since the band is empty. I said on yay. Just another diet... She laughed and told me not to beat myself up if I didn't lose any over these next 5 weeks. This is the ONLY time I wish I opted for bypass! Lol

My fill will be 6 weeks after surgery. I was banded 4/23 and my fill is on 6/5

I did not have a preop liquid diet - all surgeons have different requirements. I don't think it will keep you from having surgery- they are just trying to shrink your liver a bit to make for easier access during the surgery. I would say you are fine as long as you aren't gaining weight.

Yes they use that incision to do all the work inside. That being said, they would not place the port there because of all the scar tissue from that incision. So like I said before, your port is not there, and if it is, well, that's another issue for when you go to get fills.

Are you sure it's the port one? If it is the biggest, most painful one, my nurse at the hospital assured me that is not the port. It is the one the surgeon worked through; the one they put the band in through.

My lower abdomen is almost completely numb after two csections. It still freaks me out, it never goes away, it's completely damaged nerve endings. It will be itchy, i go to scratch and cannot feel a thing. Not sure how common that is with laproscopic surgeries, but it is rather common with open surgeries. Something no one tells you about!

Nope, the big one is the incision that the surgeon used to get the band inside...most likely on your right... Port is supposed to be lower left... I cannot feel port at all

You have to add protein powder to your food? I haven't heard that one. I was just told to make sure I get 60gr of protein or more per day, whether it's from food or shakes it doesn't matter...

I am day 6 and feel pretty good other than my chest being tight and I still have gas, feels like indigestion. I could really use some food though, this liquids thing is for the birds! I keep telling myself its just a few more days till mushies. Cannot wait to have some cream of wheat! Lol

I was banded on 4/23. I was told to take my bandages off on 4/25. When i did, I found that there were steri strips under. They fall off on their own. They have been starting to peel, so I assume they will be gone when i go back Tuesday for my follow up.

I havent a clue where my port is either. The largest incision is still sore, but that's definitely not the port.

Not really sure! I am only allowed broth, water, sugar free Popsicles( although i swear the ones they were giving me at the hospital were not sugar free) and sugar free jello. Adding protein shakes tomorrow. The tightness in chest is making me wish I didn't do this. I am hoping it goes away!

Oh, and the sharp pain, if it's the same as what i am feeling, is due to swelling causing wicked restriction at this point. I was told it should subside. My band is also empty.

I was just banded on 4/23 as well and I am also starting to feel hungry. I didn't have much pain at all, but I am still rather swollen and have lots of gas in my chest. Been walking to try and get it it move. Tomorrow I should be allowed to move from the clear liquid stage to full liquids. Are you still on clear?

Eek! Jay Robb stuff has the most horrible aftertaste, at least the ones I have tried. I wish I could stomach them, because it gives me more energy than anything else I have tried. My nutritionist told me that muscle milk lite is not on their diet because there isnt 25 or more grams of protein..... I wish I could remember the ready to drink that I got a sample of and LOVED. How did I let myself forget??! Arrgh

4 more days for me and I have been going back and forth between whatever, no big deal to what the hell am I doing? Lol

I am choosing the realize band because of the flatter port. Otherwise, they seemed pretty similar to me. My surgeon said she uses them both equally, and if I didn't have a preference she would just use whatever her other patients for the day were getting.