My coordinator called in my info on Monday 3/4 and was verbally told I would be declined because I didn't have a 6 month physician supervised diet (after being told in January that my only requirement was to have "tried and failed" to lose weight). She raised a fuss and I raised a fuss and we went ahead and submitted everything anyway and I planned on using Lindstrom if I got an actual denial.

I called to check on it late last week and the nurses said it had actually been sent for a physician peer to peer review, which surprised me...I thought that was only for appeals, but she said the way THEY work (Aetna Signature Administrators...a self-funded plan being administered by a third party administrator) is that if the nurse can't say "yes", it automatically goes to peer review, because nurses can't determine medical necessity. So, I figured it was just delaying the inevitable "no."

I just got a call from the nurse, telling me that the physician director approved my surgery as medically necessary after speaking with my surgeon and PCP! Hooray! I can't wait for the coordinator to call me to schedule now.

Congrats.

Good for you for sticking with it!! Good luck!

Can you see me dancin? Yayyyyyyyyyyyyy! Congrats! can't wait for you to join us on THE BIG LOSER'S BENCH!

That is awesome!!!! Congrats to you! I wish you all the best!

Thanks y'all! I'm so excited and can't wait to be on the loser's bench!!!

Congrats!!

Surgery is officially scheduled for 4/11/13!

My pre-op diet should be "easy"...I am having oral surgery on 3/22 and won't be able to eat anyway for 7-10 (and won't want to if this one is the same as the last one I had). Hopefully I'll sleep through a good portion of the pre-op diet on pain meds!

Congrats!!!!!!!!!

Congrats. That gives me a little bit of hope. My doc has to do a peer to peer review with Aetna.