GrungeGrownUp

On 9/4/2019 at 4:27 PM, Panda333 said:

Hello, I'm the original poster - Latest update. Well last week I raised such cane with my dr's office and the insurance company. I decided to take control rather than let them rule my life. Today I get a call from the insurance company. They received my appeal and did research. it turns out there were some errors in the plan docs which caused confusion. They said "Congratulations!" I am covered and it DOES not have to be an IOQ, although they prefer it. Whoo hoo. But then they told me I had to get with my dr's office to tell them to resubmit with the clinical information showing I went through all of the steps. So I happily sent an e-mail to the business office and told them what to do. I blind copied in my surgeon because I just don't trust them.....(They were so quick to give up on me) I told them to kindly re-submit and gave them the person's name (RN) to reference. I basically hand delivered their job.....happy, I went on with my day....

then......... 5 minutes later........

The insurance lady I just spoke to called me back...and said...Oh I meant to tell you..... I did mention your surgeon and hospital doesn't have to be an IOQ but if an IOQ is available in your geographic area you have to use them. I went to my handy google maps. IOQ is 6 miles from my house but the surgeon I selected and have already paid $4200 is 28 miles. So.....I guess there is a chance insurance could deny again.. The funny thing is when I was first searching for doctors, I checked out Orlando Health (the IOQ) and they never called me back.....

arghhhhh...the confusion and agony of waiting. Meantime the hurricane was coming and i have been stress eating here in Florida.

Thanks for listening...

Orlando health? I have aetna a d an trying to user Dr. Smith at Advent Health in Celebration. How did this work out for you? A friend used Orlando Health and she hated the office staff and told me not to use them if I didn't have to.

You Go Girl!

That is awesome! Congrats!

On 2/18/2020 at 9:42 AM, BadWolfGirl said:

Low carb low fat high Protein but not Keto. Veggies, fruits, etc.

Why no Keto?

Not for bariatric. surgery, but I had a surgery about 8 years ago and was out for a month. When people asked, that I didnt want to tell, I gave outrageous stories like I had to be separated from my conjoined twin, or my goldfish had surgery so I had to take care of her. People got the picture real fast

7 minutes ago, catwoman7 said:

duodenal switch seems like overkill given that you only have 100 lbs to lose, but see what the bariatric surgeon says. Some will do it when you're that weight.

She recommended that I talk to the surgeon because my BMI is 43 and while I am prediabetic, my father has diabetes bad. Also, the 100 lbs is me being realistic. At my height, I should weigh between 110 to 140 lbs is what she said.

4 minutes ago, BG0103 said:

It depends, is your surgeon an IOQ with Aetna? If so they will have the three month program. Aetna is very specific about IOQ’s and some policies will not cover at all if you use one that is not an IOQ.

The 3 month is the fastest way. It typically comes out to 4 months. Your first meeting with the Bariatric team and then your first nutrition appt is typically scheduled after that.

I checked on Aetna's siteand Advent Health Celebration is not an IOQ, but the surgeon is in network for me and listed under their in network bariatric surgeons. The only hospital that is on the list has one particular surgeon that 2 of my coworkers (very large employer) have been to and both have said while the surgeon is ok, the office staff is terrible. Both recommended I go elsewhere. My plan covers the whole Advent Health System.

2 minutes ago, BG0103 said:

The surgeon typically submits for approval to insurance once your three or six month nutritional visits have been completed along with any mandatory testing.

So I have a way to go being as my first nutritional visit was today. Can anyone tell if I am reading this correctly? I have to do 3 nutritional visits?

• Multi-disciplinary surgical preparatory regimen: Proximate to the time of surgery (within 6 months prior to surgery), member must participate in organized multi-disciplinary surgical preparatory regimen of at least 3 months (90 days) duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member’s ability to comply with post-operative medical care and dietary restrictions

I have Aetna and just got my referral from my Primary to the surgeon. I am hoping Aetna doesn't give me issues. My BMI is 43. I do have sleep apnea as a co-morbidity. At what point does the surgeon get the approval from Aetna?

20 minutes ago, Uomograsso said:

Welcome and good luck on your journey. Make sure to check with your insurance on what types of WLS they cover.

I just checked and they cover Gastric Bypass, Gastric Sleeve, and Duodenal Switch.

Hi everyone. I had an appointment with my primary doctor today, and she agreed that bariatric surgery is something I should pursue, especially since insurance will cover almost all of it. She said that she wants me to talk to the doctor about the duodenal switch surgery, as she feels it would benefit me the most. The surgeon's office at my hospital said I have to either go to their seminar or watch their video and do their quizzes online before I can make an appointment. I finished those today and now they are supposed to call within 48 hours to schedule the appointment. I'm excited by nervous at the same time.

Vicky