giftoflife

I was exactly 1 week away from my gastric sleeve surgery date and the bariatric center called me and said my insurance (Aetna QPOS) denied me the procedure. They have a ton of requirements to qualify for surgery, 1 being 6 months of doctor visits, 2 years of weight loss history and what they told me was that because I was not over 40 bmi for the past 2 years that it wouldn't be approved. What a punch in the gut that was. Of course, my surgeon is out of the country on vacation so he can not call prior to next week - so surgery put on hold. I called the insurance company and they said the doctor had to do a "peer to peer" consultation, the surgeon and the medical director at Aetna. This is a phone call to explain why the surgeon thinks I should have the surgery. If all goes well (please cross your fingers for me) then they will be able to reschedule my surgery asap. If not - then the appeal process begins. I am hoping this is not the case, but I can only play this by ear for now. I never knew that being a "healthy" obese person could work against you, but since I don't have any co-morbid problems like diabetes or high blood pressure - they have to hope that my history with PCOS (Polycyctic ovaries) or a family history of high blood pressure and diabetes will work to my advantage. If you pray - could you send one up for me??? Thanks!

I was exactly 1 week away from my gastric sleeve surgery date and the bariatric center called me and said my insurance (Aetna QPOS) denied me the procedure. They have a ton of requirements to qualify for surgery, 1 being 6 months of doctor visits, 2 years of weight loss history and what they told me was that because I was not over 40 bmi for the past 2 years that it wouldn't be approved. What a punch in the gut that was. Of course, my surgeon is out of the country on vacation so he can not call prior to next week - so surgery put on hold. I called the insurance company and they said the doctor had to do a "peer to peer" consultation, the surgeon and the medical director at Aetna. This is a phone call to explain why the surgeon thinks I should have the surgery. If all goes well (please cross your fingers for me) then they will be able to reschedule my surgery asap. If not - then the appeal process begins. I am hoping this is not the case, but I can only play this by ear for now. I never knew that being a "healthy" obese person could work against you, but since I don't have any co-morbid problems like diabetes or high blood pressure - they have to hope that my history with PCOS (Polycyctic ovaries) or a family history of high blood pressure and diabetes will work to my advantage. If you pray - could you send one up for me??? Thanks!