Hi Everyone *excuse my english*

Aetna denied me last week and i'm trying to appeal now.

the reason of the denial was because of my BMI . 39 with no comorbidities.

so now i got a letter from my pulmonologist to show that i have asthma

i scheduled a sleep apnea test.

actually i gained wight after my paperwork was submitted.

so i'm wondering if i can appeal with my current wight ? *which is going to change the bmi to 41*

any advise to get the approval ?

Edited October 22, 201312 yr by Sara UAE

thank you guys for being supportive.

found out today that i don't have sleep apnea.

i'm going to appeal with my current wight ( BMI 41 ) and asthma

hope it works out.

Hi Sara UAE,

How is your appeal going? Thank goodness you don't have apnea, I have asthma as well and the cpap triggers it. Although, it would help the appeal, so not worth it.

How long have you been at the 41BMI? Have you been over 40, other times over the years? I hope it all works out for you. This process has been so disheartening.

Hi Sara UAE,

How is your appeal going? Thank goodness you don't have apnea, I have asthma as well and the cpap triggers it. Although, it would help the appeal, so not worth it.

How long have you been at the 41BMI? Have you been over 40, other times over the years? I hope it all works out for you. This process has been so disheartening.

Hi

My appeal was submitted Oct 28th . it may takes 15 days to hear from them.

my BMI in the last 2 yrs was 39 - 40. i gained weight in the past 2 months and BMI increased to 42 so i appealed with 42 BMI and Asthma. to be honest i kinda gave up and start to think about having the surgery outside US (self pay). i don't have time i'm a student and winter break is coming and it's the only free time i'll have

*fingers crossed anyway*

I'm sorry for your struggles Uber. I would look I to the self pay TJ option. I would have done that f I were denied. Luckily my approval came through yesterday.

Hi

My appeal was submitted Oct 28th . it may takes 15 days to hear from them.

my BMI in the last 2 yrs was 39 - 40. i gained weight in the past 2 months and BMI increased to 42 so i appealed with 42 BMI and Asthma. to be honest i kinda gave up and start to think about having the surgery outside US (self pay). i don't have time i'm a student and winter break is coming and it's the only free time i'll have

*fingers crossed anyway*

Hi Sara,

I know what you mean I am also feeling like giving up, but my hubby and friends tell me not to give up until the last appeal is denied.

So would you schedule your surgery for December break? Will that give you enough recoup time? Have you looked into surgeons? Good luck with everything, hoping for a positive outcome.

I'm sorry for your struggles Uber. I would look I to the self pay TJ option. I would have done that f I were denied. Luckily my approval came through yesterday.

Caligirl3,

Woohoo! :-). I am so happy for you! When will your surgery be? November? How long will you be out of work? I am so happy, you so deserve this fabulous tool.

I have looked into self pay. But I kinda want a new car, lol. My car is the same from undergrad :-P

Thanks Italian-girl' date=' the doc did not mention adding a personal letter to appeal. I will definitely do that. I need back surgery and at this weight the surgery would be very invasive (front and back incisions, with 2 surgeons) if I lose weight the surgery options open up. I am in horrific pain everyday. I have pre-diabetes, sleep apnea and high bp. I am scared, I have an 8 y/o autistic son and fear I won't be there to help him when he is older. He is high functioning, but that is with constant therapy and support. I am an only child and both my parents are gone. I will start the letter tomorrow, along with the letter with my son's diagnosis. Thx :-)[/quote']

I have a 14 year old autistic nephew. I know how hard that is on a parent. Good luck! Letters of personal appeal usually help.

Caligirl3' date='

Woohoo! :-). I am so happy for you! When will your surgery be? November? How long will you be out of work? I am so happy, you so deserve this fabulous tool.

I have looked into self pay. But I kinda want a new car, lol. My car is the same from undergrad :-P[/quote']

Thanks!!! I don't have a date yet, I'm waiting for the hospital scheduler to call some day next week, and then get my pre-op apps done. I'd bet December sometime. I hear you about self pay. I wish you were at my med group. They are amazing at getting paperwork through and approved... I'll pray for a speedy approval for you...

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Thanks!!! I don't have a date yet' date=' I'm waiting for the hospital scheduler to call some day next week, and then get my pre-op apps done. I'd bet December sometime. I hear you about self pay. I wish you were at my med group. They are amazing at getting paperwork through and approved... I'll pray for a speedy approval for you...

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Keep me posted. What do you need to do pre-op for appointments? Who knows where i'll end up(doc wise). But your group does really seem on the ball. Maybe i'll call them tomorrow and ask how it works to switch during an appeal since I moved. The thought of driving down there for all the appointments my insurance are now requiring seems overwhelming (pulmonologist and sleep specialist) the sleep specialist had a 3 month wait! My appeal is supposed to be in Friday.

Keep me posted. What do you need to do pre-op for appointments? Who knows where i'll end up(doc wise). But your group does really seem on the ball. Maybe i'll call them tomorrow and ask how it works to switch during an appeal since I moved. The thought of driving down there for all the appointments my insurance are now requiring seems overwhelming (pulmonologist and sleep specialist) the sleep specialist had a 3 month wait! My appeal is supposed to be in Friday.

EKG, GI, chest X-ray, labs... A surgeon appt. I can get all that in pretty quick once I have the procedure date. I'd call them now, because it never hurts to get a 2nd opinion. Also, you've moved so its a legitimate request. Not like you're shopping around. I can't say enough about them, they're great!

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EKG' date=' GI, chest X-ray, labs... A surgeon appt. I can get all that in pretty quick once I have the procedure date. I'd call them now, because it never hurts to get a 2nd opinion. Also, you've moved so its a legitimate request. Not like you're shopping around. I can't say enough about them, they're great!

Sent from my iPad using VST[/quote']

Any news on a date Caligirl 3?

Any news on a date Caligirl 3?

Ugh, no!!! I think I made them mad, I called and she told me I had to be patient with the process. She assured me I'd get in before the end of the year, but I'm freaking out not knowing in advance. I have to plan!!

My co-worker is getting sleeved on 12/18 and taking 6 weeks off, so I want to get in and be back by then. I'm only taking 2 weeks off. Well, one technically. Then working from home the second week.

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I'm Super ANNOYED!!! My paperwork was submitted by the Insurance coordinator at my surgeons office on Sept. 27th and whenever I call to find out the status of my Pre-cert they keep saying its pending! I mean why so long?? I fit the requirements for the surgery and I followed their rules to the "T"!!! My BMI is 54, I'm pre-Diabetic, Hypertensive and suffer from joint pains due to this excess weight. How could you take this long to approve me, or any of us for that matter!