Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Impatiently waiting for Aetna



Recommended Posts

Mazzers120' date='

That sucks! People just don't use common sense. I mean if the BMI is still over 40 who cares how tall you are, lol. Funny thing though, I was 5'4" most of my life. I had back surgery in 2008 and honestly hadn't measured my height in years, I was shocked when they measured me at the nut appointment and I was 5'2". Not sure how old you are but our height does change as we age. I am 45[/quote']

I felt like saying, well when I put on that 75lbs it weighed me down an inch

Share this post


Link to post
Share on other sites

Ok ladies and gents. Got a question for any and all to answer. Please.

I am going to a dr in indiana. I have UMR insurance. Will I have to complete the six months of dr monitored weight loss BEFORE they submit to insurance or just after all the other stuff? The only thing I think I need is the six months (now down to three). My psych eval is done. I am worried if they submit before the 6 months I will get denied. I am worried if it is after the 6 months, I will have something else to do that I could be doing now. Any thoughts?

Share this post


Link to post
Share on other sites

You shouldn't submit until you've completed it' date=' or they will most likely deny[/quote']

Anybody use weight watchers as part of the weight loss attempt? Did insurance count it? I am calling in the morning. Just getting antsey. Lol

Share this post


Link to post
Share on other sites

Anybody use weight watchers as part of the weight loss attempt? Did insurance count it? I am calling in the morning. Just getting antsey. Lol

I did use weight watchers and my primary care physicians weight history

Share this post


Link to post
Share on other sites

I felt like saying' date=' well when I put on that 75lbs it weighed me down an inch[/quote']

Here here, a witty retort makes us all feel better :-) (even if it's only in our mind) But seriously I was mortified I lost 2 inches bet my weight helped it along. Hey I also saw you on the Mexico thread. Have you called/emailed OCC? I'm gonna contact them tomorrow. Batman sounds fab.

Share this post


Link to post
Share on other sites

Here here' date=' a witty retort makes us all feel better :-) (even if it's only in our mind) But seriously I was mortified I lost 2 inches bet my weight helped it along. Hey I also saw you on the Mexico thread. Have you called/emailed OCC? I'm gonna contact them tomorrow. Batman sounds fab.[/quote']

Well I did email them, and it seems like they can get me fairly quickly. I'm just waiting to here from my surgeon here to see if insurance pulls through. What a pain in the a**. it's my policy, I pay for it, insurance should not be able to govern our medical care!!! I have always said "those who do not vote can not b****" I will be voting now!

Share this post


Link to post
Share on other sites

Well I did email them' date=' and it seems like they can get me fairly quickly. I'm just waiting to here from my surgeon here to see if insurance pulls through. What a pain in the a**. it's my policy, I pay for it, insurance should not be able to govern our medical care!!! I have always said "those who do not vote can not b****" I will be voting now![/quote']

That is great that there is another option. Have you heard anything from Insurance? I am also very disappointed in our insurance. We were told we had a "Cadillac" plan and my husband company even pays extra to cover bariatric. What good is a caddy if it doesn't run when you need it. My hubby says no way to Mexico, but I think I just need to educate him.

Share this post


Link to post
Share on other sites

That is great that there is another option. Have you heard anything from Insurance? I am also very disappointed in our insurance. We were told we had a "Cadillac" plan and my husband company even pays extra to cover bariatric. What good is a caddy if it doesn't run when you need it. My hubby says no way to Mexico' date=' but I think I just need to educate him.[/quote']

I agree I am disgusted with aetna! The peer to peer was denied today so now they are telling me to file another appeal.

Share this post


Link to post
Share on other sites

Ladies I am so sorry everyone is having insurance drama. I am 7 days post op now and in the healing process but let me tell you that I have been on this journey for almost a year...January would have made a year.

Aetna was my 1st insurance and they flat out denied me, they really don't like paying for this surgery and I was paying about $700 out if pocket for my plan. I was thoroughly disgusted...I dropped them and later lost my job, ended up with medical assistance and a MCO called Priority Partners who have me way less drama and approved me back in September after a peer to peer. They take good care of me, even sends a nurse to check on me twice per week.

Stay positive, things will work out soon. And again I'm so sorry for the road blocks some insurances put up. It's awful.

Share this post


Link to post
Share on other sites

So I'm just so frustrated because Aetna still hasn't made a decision about my surgery! I have completed my 90 day diet and exercise with a Nutritionist and Personal trainer.My BMI is 54, I'm a pre-diabetic, hypertensive, I have joint pains due to my weight, I've done my Psych evaluation, I have been to group sessions and did all of my Pre-op labs. They've had all this info/paperwork since September 27th. Every time I call they say "It's still pending" I don't understand why it's still pending. Their requirements are a BMI of 40 or more and at least 1 co-morbidity and following a 3 or 6 month diet and exercise plan and I did that to a T!!!!!!! So why is it taking them forever to give me an approval???? It's frustrating and I'm highly annoyed with Aetna right now!!!!

Share this post


Link to post
Share on other sites

Hi All,

I had my surgery on Tuesday. I have been home since Thursday. Got on the scale today and still no weight loss. I am hoping its from all the fluids in the hospital. I can't get down much Protein at all . Trying to get as much as I can in fluids. This is so hard. Still very sore.

Share this post


Link to post
Share on other sites

I REALLY hate that they keep giving you this run around for trying to get healthier. I will cost them less in the long run b/c you will have less issues that you have to see other Dr's about. But keep on staying positive and don't settle for no...and you will get your approval.

I agree I am disgusted with aetna! The peer to peer was denied today so now they are telling me to file another appeal.

Share this post


Link to post
Share on other sites

Hi SoPeachy,

That definitely sounds way too long. Have you called them and your surgeon's office? What did they say? I was told on the phone that they have 30 days to give you an answer. But remember that 30 days resets every time they ask for more info. So if your doctor had to send in additional information they have another 30days. Your case sounds cut and dry, if they do deny you, get your letter and go over your records. Turns out I was denied because my height had been entered incorrectly on two gp visits. Don't give up. Hope it all works out quickly

So I'm just so frustrated because Aetna still hasn't made a decision about my surgery! I have completed my 90 day diet and exercise with a Nutritionist and Personal trainer.My BMI is 54, I'm a pre-diabetic, hypertensive, I have joint pains due to my weight, I've done my Psych evaluation, I have been to group sessions and did all of my Pre-op labs. They've had all this info/paperwork since September 27th. Every time I call they say "It's still pending" I don't understand why it's still pending. Their requirements are a BMI of 40 or more and at least 1 co-morbidity and following a 3 or 6 month diet and exercise plan and I did that to a T!!!!!!! So why is it taking them forever to give me an approval???? It's frustrating and I'm highly annoyed with Aetna right now!!!!

Share this post


Link to post
Share on other sites

Hi UberBuffaloGal,I agree that's definitely way too long! My surgeons office did call to check with them and they will check with them again this week! I have called them. I try to wait about 2-3 days before calling to give them some time. From what I was told on 11/6 was they asked for something else on 10/2 and received it on 10/3. So I didn't call back until 11/4 but still it's pending! I will not give up! But they're getting on my nerves.

Hi SoPeachy,

That definitely sounds way too long. Have you called them and your surgeon's office? What did they say? I was told on the phone that they have 30 days to give you an answer. But remember that 30 days resets every time they ask for more info. So if your doctor had to send in additional information they have another 30days. Your case sounds cut and dry, if they do deny you, get your letter and go over your records. Turns out I was denied because my height had been entered incorrectly on two gp visits. Don't give up. Hope it all works out quickly

So I'm just so frustrated because Aetna still hasn't made a decision about my surgery! I have completed my 90 day diet and exercise with a Nutritionist and Personal trainer.My BMI is 54, I'm a pre-diabetic, hypertensive, I have joint pains due to my weight, I've done my Psych evaluation, I have been to group sessions and did all of my Pre-op labs. They've had all this info/paperwork since September 27th. Every time I call they say "It's still pending" I don't understand why it's still pending. Their requirements are a BMI of 40 or more and at least 1 co-morbidity and following a 3 or 6 month diet and exercise plan and I did that to a T!!!!!!! So why is it taking them forever to give me an approval???? It's frustrating and I'm highly annoyed with Aetna right now!!!!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×