must switch surgeons 3 week prior.......ugh

[melissa45154 2]

I have Aetna through my husband's work. They have a special program that I can do the 6 month in 3 months. It is not the multi-disciplinary...just the regular physician supervised diet. Anyway, I have been working with this Surgeon's office that I respect and trust so much. He is the chief of surgery at his "main" hospital, and he has done a few surgeries on me to fix a botched surgery that someone who calls themselves a surgeon did to me. It has taken 3 years to correct all of her mistakes.....Anyway, I have done the sleep study (have severe sleep apnea), the pysch eval, and I have 3 weeks left of my nutrition program and then we can submit to insurance...yeah, almost there. I found out Wednesday from my case manager that my particular plan requires I go to an Aetna Institute of Quality. There are about 5 in the Dallas area. My surgeon is not affiliated with any of those hospitals.....Ugh!!!!! His asst. went to see if he can become affiliated with one of them and he is not able to. So, I'm pretty much finished with my program and have to switch. My doctor's office was great and got me into another Surgeon's program. The only thing they are making me do extra is go to their seminar. Which I do Wednesday. I know he is a great doctor. He actually trained my original surgeon. I guess I'm just getting nervous, and with all the problems I had a few years ago I'm even more nervous. We are submitting to insurance on Dec. 5 with my case manager calling me on Dec. 8 or sooner with the verdict. Fingers crossed I will have my surgery before the end of the year.....I guess I really don't have any question, I'm just kind of letting it out. I want so desperately to be approved. I've done everything asked, but don't want them to say sorry it's a no go......and now I'm even more nervous with having this new team do the procedure and I haven't even met them yet...

[Corrigan 75]

I know you don't think so, but I think this is a plus for you from the information you've given. Too many people come here

with stories of surgeons who operate and don't provide much pre or post op support. The seminar you're going will provide

you with some very valuable information to help you through your ordeal. The band trip isn't the easiest thing you've ever

done, it will take some hard work on your part. Having a competent surgeon is half the battle, your attitude and effort is the

other. Be happy you're going into an organized program, It'll make your journey a lot easier.

[Pashion 7]

I have Aetna through my husband's work. They have a special program that I can do the 6 month in 3 months. It is not the multi-disciplinary...just the regular physician supervised diet. Anyway, I have been working with this Surgeon's office that I respect and trust so much. He is the chief of surgery at his "main" hospital, and he has done a few surgeries on me to fix a botched surgery that someone who calls themselves a surgeon did to me. It has taken 3 years to correct all of her mistakes.....Anyway, I have done the sleep study (have severe sleep apnea), the pysch eval, and I have 3 weeks left of my nutrition program and then we can submit to insurance...yeah, almost there. I found out Wednesday from my case manager that my particular plan requires I go to an Aetna Institute of Quality. There are about 5 in the Dallas area. My surgeon is not affiliated with any of those hospitals.....Ugh!!!!! His asst. went to see if he can become affiliated with one of them and he is not able to. So, I'm pretty much finished with my program and have to switch. My doctor's office was great and got me into another Surgeon's program. The only thing they are making me do extra is go to their seminar. Which I do Wednesday. I know he is a great doctor. He actually trained my original surgeon. I guess I'm just getting nervous, and with all the problems I had a few years ago I'm even more nervous. We are submitting to insurance on Dec. 5 with my case manager calling me on Dec. 8 or sooner with the verdict. Fingers crossed I will have my surgery before the end of the year.....I guess I really don't have any question, I'm just kind of letting it out. I want so desperately to be approved. I've done everything asked, but don't want them to say sorry it's a no go......and now I'm even more nervous with having this new team do the procedure and I haven't even met them yet...

I know exactly how you feel, my insurance is Tricare Prime (military) thru my husband, and I was going thru a civilian Dr. who is awsome, to have my surgery and we had a date set for Nov 11th. I did everything Tricare and the surgeon required of me within a months time (6 mths weight management not required). The surgeons office sent my paperwork to Tricare on Oct 23rd I was approved on Oct 24th but with modifications. Because Tricare is military I have to go to their military WLS center and my heart just dropped. Now I have to start the whole process all over at the military WLS center and they are so booked that my first consultation is not until Dec 6th. I don't even know the name of the surgeon they assigned me to. So like you I am very nervous at this point. Plus I paid out of pocket for the psych eval and the nutritionist and none of that even matters now. It is so discouraging to have a surgery date of Nov 11th to now having to wait til Dec 6th for consult and probably not having my surgery til next year because I heard that they require a lot of testing before the surgeon will agree to do the procedure, which could take up to 2 months before all the results are back. I do not understand why insurance companies do not tell you up front just go to this place first, because that is were you will end up at anyway...But good luck, you have done all that is required so you will be approved. I use to process claims for Aetna, they can be tricky sometimes, if they deny you appeal it and show them you mean business. They do not like unhappy clients.

[rn2012 6]

I hv aetna too, and my paperwork is being turned in on 11/17, im nervouse as all heck b/c i know aetna wants u to have a bmi>40 for 2 plus years, im keeping my fingers crossed

[melissa45154 2]

I hv aetna too, and my paperwork is being turned in on 11/17, im nervouse as all heck b/c i know aetna wants u to have a bmi>40 for 2 plus years, im keeping my fingers crossed

I know...I haven't had a bmi of that high for 2 years...only in the last 6 months. Although I have been above a 35 for 2 years, but didn't get diagnosed with my co-morbidity until last month......I voiced that concern to my case manager. While I was on the phone with her she IM'd a pre-cert nurse with Aetna. That nurse says, that she doesn't really look at the detailed 2 years, and just really looks at the current situation. Unless, there is some other red flags.....My case manager told her all about me and she said if she was my pre-cert nurse she'd approve me, so I'm feeling a little better about that issue.....The stress can be overwhelming. Let me know how it goes for you. I have been told that Aetna is one of the fastest to make a decision. At least there shouldn't be a long delay from submitting to finding out....fingers crossed

[melissa45154 2]

I know exactly how you feel, my insurance is Tricare Prime (military) thru my husband, and I was going thru a civilian Dr. who is awsome, to have my surgery and we had a date set for Nov 11th. I did everything Tricare and the surgeon required of me within a months time (6 mths weight management not required). The surgeons office sent my paperwork to Tricare on Oct 23rd I was approved on Oct 24th but with modifications. Because Tricare is military I have to go to their military WLS center and my heart just dropped. Now I have to start the whole process all over at the military WLS center and they are so booked that my first consultation is not until Dec 6th. I don't even know the name of the surgeon they assigned me to. So like you I am very nervous at this point. Plus I paid out of pocket for the psych eval and the nutritionist and none of that even matters now. It is so discouraging to have a surgery date of Nov 11th to now having to wait til Dec 6th for consult and probably not having my surgery til next year because I heard that they require a lot of testing before the surgeon will agree to do the procedure, which could take up to 2 months before all the results are back. I do not understand why insurance companies do not tell you up front just go to this place first, because that is were you will end up at anyway...But good luck, you have done all that is required so you will be approved. I use to process claims for Aetna, they can be tricky sometimes, if they deny you appeal it and show them you mean business. They do not like unhappy clients.

I hope all goes well for you. I go to my seminar and consultation tomorrow so we will see how that goes. Hopefully, they can transfer all of your previous doc's evaluations and you can squeeze it in before the end of the year. That is what I am hoping for......Goodluck to you and let me know how everything goes for you.

[melissa45154 2]

I know you don't think so, but I think this is a plus for you from the information you've given. Too many people come here

with stories of surgeons who operate and don't provide much pre or post op support. The seminar you're going will provide

you with some very valuable information to help you through your ordeal. The band trip isn't the easiest thing you've ever

done, it will take some hard work on your part. Having a compent surgeon is half the battle, your attitude and effort is the

other. Be happy you're going into an organized program, It'll make your journey a lot easier.

Thanks for your kind words. I did go through an actual program. Not all Aetna clients are required to go through this "inst. of quality". Anyway, you are right 1/2 the battle is the attitude. I'm wanting this so badly, and am ready for it. This is just one more hurdle to prove I can do this. Thanks