settebee

I would at least call your pcp's office and ask to speak to one of the nurses to see if they think you should come in. I'd of course tell them about being sleeved. I hope you get to feeling better.

I'm so sorry you had to go through that! People are such jerks sometimes! I hope you have a better day! :confused: And girl, file the compliant! Let them hear you until the sun comes up! Good luck!

Michelle,

P.S. Congrats on being able to get your sleeve!! :biggrin2:

Michelle,

Thanks for the inside, but make sure I have this right. You recommend I contact my HR dept and ask to speal to benefits who handles the the insurance claims and ask them if they could over approve my appeal?

Thanks for your help in advance.

Suzette

Hi all!

I was denied by Aetna due to "lack of weight history". I submitted my weight from 07, 08 and this year; not much has change. I went to my gym and had them type up a letter stating my weight from 09. I hope that works! My question is: how long does it take to hear back from your appeal? I'm super nervous!

Thanks for your help in advance. :lol0:

Hey! I'm in the same boat as you guys! I too was lacking weight records. I had weights from 07 and 08, and I was denied just yesterday. My BMI is too higher than 50 and still that wasn't good enough. I went to my gym and had the manager type me a letter with my starting weight from August of 09. I hope it works! Just be sure if you have documents from your gym that it's typed in their letterhead! Good luck! I know it's frustrating. My appeal will take up to 30 days with Aetna! Wish me luck! :001_smile:

I am going through the same problem. I didn't have my weight or bmi documented for 2009, but I ended up going to my gym and asked them to type a letter on their letterhead stating my weight during that time. Maybe you could do that or pull together logs of you weight and weight loss during that year? I hope this helps a little. :001_tt2: Good luck!

I did the three month prep as well. Month one I saw the doctor, did my psyche evaluation, saw the dietian and fitness guy and one support group, month two dietain and fitness guy via email and the last month same as first minus the psyche evaluation! :001_tt2: Good luck!

Hey Connie,

I have Aetna POS, and I've been waiting now over a week. My insurance specialist said it could that 15 to 30 days the longest! Boo! Good luck!

I'm confused about this. I, too, have Aetna and my surgeon's office said that the three-month multidisciplinary program consists of the nutritionist, psychologist and the dietician/doctor visits in their office. Although it says in the bulletin that a supervised exercise program is required, she said that this was all we had to do and that the psychologist would monitor our exercise (we would talk with him about what we were doing as part of the behavior modification. She also said that they would keep track of everything themselves and get updates from the nutritionist and psychologist. My daughter and I are going on our third month and I do not want to find out now that we were supposed to be doing a supervised exercise program. Does anyone know exactly what is required? I've had people say all kinds of things.

All the exercise program is you talk to "fitness guy" each month about what kinds of exercise you have been doing. For example, month one I walked 2 days a week for a mile, month 2 I picked up swimming a few days a week since the weather permits and still walked, third month walked, swam some and trying workout dvds. They just want to see you are making exercise a priority as well in your journey of weight loss. Nothing scary, just a few questions on what you are doing different. :001_tt2: I hope that helps.

May 5th I started my 90 day supervised diet with my surgeon. I'm officially a third of the way done! I got my upper gi done, psyche evaluation, saw the dietian and fitness guy all today! I've already completed all of my recommended support groups, got my copies of my medical history, and saw the doctor. All I have to left are my touchbases (via email) with my dietian and fitness guy in july, and then august I have my finally visit with the doctor, dietian and fitness guy before they send it all to the insurance!! Yay!!!! :devil_smile:

Ok! I was wondering does the insurance verify the letter of recommendation? I hope I don't sound shady katie, but my pcp is taking forever and I don't think he wants to write it. My mother in-law is a RN, and works with doctors (obviously), and she said she could write it. Is that terrible of me! Any suggestions?

Thanks in advance!

You're so very welcome!

Honestly, I'd just show up. Ha! That's what I did. I told the lady behind the counter I was interested in the lapband. She took my license and insurance card, made copies and gave me a packet to fill out. I turn it in and thank her. She stops me and says oh your insurance specialist will come out and talk to u on what ur insurance covers. I talked with the insurance specialist for 20 minutes if that and she gave me the chose 6 month diet with pcp or 3 month with the surgeon. I took the 3 month plan, and she gave me everything I needed to do each month! Ha! Easy! What city and state do u live in?

Suzette

Jess,

Today is your lucky day! I actually saved the codes they are as follows: The CODE for LAP-BAND® for insurance purposes is CPT 43770, diagnosis code 278.01: morbid obesity.

I understand wanting to look amazing for ur sister's wedding. Next summer my husband and I are renewing our vows on the beach, so I want to look sharp. Ha!

Going through ur pcp is smart, but to me it's timing consuming. I rather go straight to the source, but u r more patient than me. :eek: Good luck and keep me posted. Suzette

Prdmommy,

I just read over my aetna package about wls. They do cover the band and now the sleeve. The cover psyche evaluation and all visits with dr, etc. All you pay is your copay. Then for the surgery u pay 20% of the procedure and hospital stay one u meet ur deductible.

Suzette

Thanks for the heads up!

Are in a hospital gown? Are you allowed to wear a bra with underwire?

Thanks again!

I know what you mean; I feel the same way! My insurance specialist told me as long as I do everything I'm suppose to do in the three month time line that I'll be fine. I have Aetna, and she said Aenta and Cigna both are good for speedy approvals. So stick with your three month prep and you'll do fine! Good luck!

Suzette

Hey Jess!

After reading your comment, it sounded a lot like me. I was considering the surgery and worried bc I haven't been to the doctor in years and "my insurance won't pay". What insurance do you have? In most cases your insurance requires 2 to 5 years of medical records, but you can use your jenny craig as records too. Don't be discouraged! I'd look into different weight loss surgeons in your area. You have nothing to lose! :thumbup: Good luck!

I had my first visit with my doctor on Monday, and he wants me to get an upper GI.

What are the details of an upper GI? I know they make you drink a Fluid and take pictures of your GI tract. How long does it take? Is the fluid have any effects like upset stomach, vomitting? Does everyone have to have an upper GI done?

Thanks in advance!

Suzette

Oh wow! I didn't realize Vanderbilt did WLS. Neato! I'm with Dr. Morton at Baptist Hospital.

Well there in the office I have the insurance specialist who is going to submit everything to the insurance. At the beginning (last month) she, Tina, gave me a three month time line of everything I need to do each month. I jumped on board and knocked out what I could. At the end of the last month, in August, she'll send it off. Tina told me as long as I do everything on list and my BMI was 40, I had a 95% chance to be approved through Aetna.

Ms. Melissa

You're so welcome!

Did they offer you the 3 month program instead of the 6 month? What insurance do you have? Have you done your support groups yet?

Yeah, you're right! I could switch, but would I have to start all over with the dr visit, or would they just transfer my paperwork? I could always email my insurance specialist and see what she recommends. I told my husband about it and said that I could be being sensitive. (I can be at times) Maybe I was excepting some one a little more up beat with a better bedside manner. After all between me and my insurance, we are paying about 20K. That should give him something to smile about right?! Haha! :thumbup: Sorry, now I'm just being ugly.

Yeah, the doctor does the fills.

Awww!!! Awesome!! Good for you!!! :thumbup:

Thanks for the insight. I had my first dr appt with Dr. Morton and honestly I wasn't impressed by him. He just seemed arrogant. :/ Seeking help for WLS is hard enough, I don't need a arrogant doctor that talks to me like I'm an idiot. But I only have to see him a few more times til surgery, so I'm not worried about it.