Impatiently waiting for Aetna

[mazzers120 75]

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

[mamaof5heathens 18]

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?

[Jessica108 10]

You shouldn't submit until you've completed it, or they will most likely deny

[mamaof5heathens 18]

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

[shelley_38 10]

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

[UberBuffaloGal 20]

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.

[mazzers120 75]

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!

[UberBuffaloGal 20]

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.

[mazzers120 75]

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.

[MsK1972 112]

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.

[SoPeachy28 53]

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!!!!

[bosoxgirl1966 20]

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.

[Soontobethinner 9]

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.

[UberBuffaloGal 20]

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!!!!

[SoPeachy28 53]

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!!!!