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Impatiently waiting for Aetna

Jessica108

By Jessica108, in Insurance & Financing

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bosoxgirl1966    20

bosoxgirl1966
Posted

I have Aetna POS II plan. My BMI is 39.7 and I have high blood pressure and sleep apnea. My info was submitted to Aetna on Wednesday and I called today and it is still pending but they did tell me it was being currently reviewed by the nurse. I wish I thought of submitting a letter with my file. I guess if I need to appeal I can include one

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Jessica108    10

Jessica108
Posted

So, Aetna gave the impression I was going to get approved if I had my sleep study done, HOWEVER, since they denied the test, the waiting game goes on. Here's hoping I get some positive news in the next few days.

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MrsYoungJr    4

MrsYoungJr
Posted

I have Aetna. I haven't submitted my paperwork yet still waiting on them to decided about this whole sleep apnea mess. I just had my 3rd sleep study. The 1st was a split night. Meaning if my breathing got bad enough then she would wake me up and put me on the machine. Well she didn't wake me up but she said they still may make me come back cause I had some moments but nothing severe. Well my 2nd one they put me on the CPAP the whole night. Results came back and they said I didn't tolerate the CPAP so the wanted me to come back and get on the BYPAS now I'm waiting to see about that. I'm going to the Dr. this morning when my husband gets home. I have to get the rest of my paperwork together so I can get ready to send off for approval.

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nh20013    15

nh20013
Posted

I just literally got back this morning from sleep study #2 ... OMG that Cpap was horrible but I rode it out all night! As soon as I get the results I'm submitting the paper work for my appeal! Hopefully this will do the trick!

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bosoxgirl1966    20

bosoxgirl1966
Posted

I have severe sleep apnea. I always knew it but never had been diagnosed until I started this whole precertification process. I can finally sleep more than an hour at a time. Its incredible. You get used to the mask. My results showed I stopped breathing 62 times every minute

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nh20013    15

nh20013
Posted

Yeah I had never thought of doing a sleep study let alone think I had apnea but when I got denied at a 41 bmi with high blood pressure I figured I would have the study done much to my surprise I have severe sleep apnea too not sure how many times in one hour I stopped breathing ... Hopefully I will get my approval lose this weight and not have to worry about it.

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bosoxgirl1966    20

bosoxgirl1966
Posted

If I dont het approved I am going to be devastated..trying to get all this completed before deductible kicks in again

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shelley_38    10

shelley_38
Posted

I am patiently waiting to hear back from Aetna about my surgery. The waiting is driving me crazy :angry: !!!

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nh20013    15

nh20013
Posted

I know how you feel I am submitting my appeal tomorrow and will have to start all over with the waiting game hopefully the review of an appeal doesn't take as long!

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shelley_38    10

shelley_38
Posted

What do you have to include when your doing an appeal? Did your surgeon do a peer-to-peer review with the medical director before having to do an appeal? Wanted to get a jump start in case I get denied. Thanks for any information anyone can give me! :)

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nh20013    15

nh20013
Posted

Yes they did a peer to peer and it was denied too... Just from the different post I've read I wrote my own letter, also had my PCP write a LMN and submitting my sleep study results .... If anyone else has any suggestions please let me know I am going to submit tomorrow!!

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mazzers120    75

mazzers120
Posted

Yes they did a peer to peer and it was denied too... Just from the different post I've read I wrote my own letter' date=' also had my PCP write a LMN and submitting my sleep study results .... If anyone else has any suggestions please let me know I am going to submit tomorrow!![/quote']

Did you have sleep apnea? I'm doing my sleep study tonight. This is becoming a really long process :(

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nh20013    15

nh20013
Posted

Turns out I did have it had to do a second sleep study with the CPAP ... Wish the surgeons office would have suggested I do it before my denial ... Trust me I know it's frustrating I completed my 90 day period on 8/16 and was so excited thought I would be sleeved by now.

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nh20013    15

nh20013
Posted

I have Aetna POS II plan. My BMI is 39.7 and I have high blood pressure and sleep apnea. My info was submitted to Aetna on Wednesday and I called today and it is still pending but they did tell me it was being currently reviewed by the nurse. I wish I thought of submitting a letter with my file. I guess if I need to appeal I can include one

Have you heard back ?

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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