freemommy×4

That's what I was thinking @magtart...I wonder if they will do the surgery anyway? I am willing to suffer! Lol

Finally got the word that I am approved for surgery. Celebration time right?! Not so fast my friend...they denied me for some type of pump 64999 is the billing code. Can't get my insurance coordinator on the phone to explain for me. What does this mean? Anyone know?

So nerve wracking!! I didn't allow myself to eat all day...until my last weigh in was done! You've got this!

Congrats!!!!????????????????????

I understand the frustration! Today is the last day for Aetna to decide on my appeal. They won't tell me anything! Just keep saying it is open as of now and to wait 7 -10 days for a letter.????

Today is the day Aetna has to return a decision on my appeal. I called yesterday...they said it was still open. Called just now and they said they won't know anything until 2pm, but that a letter with their decision will be sent to me. I don't want to wait 7-10 more days on a letter. So my question is...should I continue to call them today to try and get an answer? Will they tell me over the phone? Maybe I am reading too much into this...but it feels like a bad thing that they are so hesitant to tell me anything over the phone!

@thepostop Thank you so much!!

I should hear tomorrow about my appeal with Aetna. I was denied over a technicality and a "deadline" for my clinicals to be turned in...they nev er even reviewed my info. So now I find out our insurance policy is changing with Aetna the first of the year. Of the four policies offered NONE cover bariatric surgery. I am trying not to freak out right now. The "what ifs" are getting to me. Please someone say it will be ????!! Lol

Oh man! I hope for your sake that they are wrong! All that hard work! I'm sorry I don't have any answers for you! Seems pretty unfair to me!

Awesome!! Congrats! Can't wait to see my numbers improve! Love it!

Thanks @InnerSurferGirl!

Well the nurse from Aetna called this morning. She said that even though Texas requires a 72 hour turn around because my info was submitted on a Fri it had to be in be noon. So I guess they get to make the rules up as they go along. I am going to wait and see what happens with my appeal and then look into an IRO if I get denied again.

Oh and my durn profile pic is crooked and I cant get it to flip. *Big Sigh* even the little stuff is getting to me now! Lol

Lol that is exactly what it has been! So much conflicting information! I finally was able to get them to say Texas law states there is a 72 hour turn around time. My clinicals were requested 10/16 at 3:07 they were faxed at 3:30 and I was denied at 4:39 so there basis of denial being that they didnt receive clinicals before I was denied by the medical director is a total lie. So after several hours of being on hold and speaking to everyone's supervisor, the nurse is calling me in the morning! I realize they won't overturn the denial but I am going to ask that my appeal be expedited due to their "mistake".

Thank you!!

Called Aetna and they say my appeal should be decided by Nov 4th. As far as the time limit on the turn around? They said it was 24 hours my surgeon's office submitted everything on the same day. So they are really just being dishonest. The rep with the precertification department was so rude...she wouldn't let me speak and intterupted me constantly. I am sooooo frustrated right now! This never should have been denied...and all I can do now is wait.

I want to call Aetna and bug them...but I don't want to interfere with what the insurance coordinator is doing. But I really want to call.

I was told by Aetna and my Dr's office I didn't need one because my bmi is so high. Do you think i should get one anyway?

I am wondering if I should get a letter from my doctor anyway. The insurance coordinator said they had already filed an appeal though...so maybe it is too late.

According to the insurance coordinator at my Dr's office she was told by Aetna that she missed a 72 hour deadline to have all of my clinical info faxed to them. Which doesn't make sense because she submitted on a thursday and I was denied the next day. Aetna told me they denied it because they had received no proof of medical necessity. The IC said she had never had this happen before. So... I am not sure what to believe! But I didn't get a letter of medical necessity from my GP because I was told with my bmi and co morbidity I didn't need it.

I am freaking out on the inside,but trying to look calm to everyone around me. I went through a three month program of psyc eval, dietician, supervised 1200 cal a day diet. After my last weigh in I was told by my Dr's office everything had been submitted and two weeks later I get my letter denying coverage. The reason is because Aetna said they didn't receive any proof of medical necessity. My Dr's office didn't meet the dead line. The appeal has been filed. I am ????