So after 6 months of tests and appts I was called by the nurse at my surgeons office to tell me that my surgery was denied.

I am HEARTBROKEN. ????

I have been though so much this year.

As I started this journey, one month in, my 37 year old husband had a heart attack. Which then required a triple bypass because of 3 blockages. We made it through 20 days in the hospital, 6 days in the cardiac ICU.

We both quit smoking, and I was determined to keep going forward with this. I kept my appts and tests even with him in the hospital. Just so I could have this done and we can BOTH start our new lives together.

Because when he was in the hospital I could barely BREATH let alone eat. I lost 15 pounds.

Now because I quit smoking and my husband is recovering slowly but is recovering nicely, I began to eat. I'm starving. I'm following exactly what I should and I put on 10 pounds. I started a celexa for depression and blood pressure meds a few months ago.

I was denied because of the weight gain through the 3 month nutrionalist appts.

I am so sad, I am so depressed.

I feel defeated.

I plan on appealing. I don't know how to pick myself up from this.

Thanks for reading, advice would be greatly appreciated.

Katie

God bless you Katie, and I hope it gets better for you. It doesn't seem fair that insurance would deny a surgery that has such benefits just because someone has multiple complex issues that could cause a weight gain or loss. If I was an insurance company, I would take a holistic look at the person after their six month trial, and if they met all the checklist requirements (BMI, co morbidities, commitment, etc.) just approve it. Hopefully this will turn around for you and start a good momentum...

I also have Aetna insurance and the whole six months of Dr visits I didn't know I could not gain so of course I was denied cause I did!!!! Well after feeling defeated I talked to the Dr office and was told I could do the three month program of dr visit, nutrician and excersise program they offer. My hospital had a program just for bariatric patients to do so they can get approved. I have lost 8 with it and as long as insurance sees a life style change I was told I will get approved.

You could also call the surgeon's office and see if he would be willing to do a peer to peer review with the insurance company. That might be quicker than starting a full blown appeal. If the peer to peer doesn't work you can still appeal.

You could also call the surgeon's office and see if he would be willing to do a peer to peer review with the insurance company. That might be quicker than starting a full blown appeal. If the peer to peer doesn't work you can still appeal.

The nurse said she was on the phone with them all morning the day I found out I was denied. She said they wouldn't budge.

I'm still working on my appeal letter.

Thanks for the info tho I will double check that they did the peer review.

Appeal appeal appeal and don't give up!! I have been fighting with my insurance and their medical cost management company since May 4th and I finally got my verbal approval on Monday. I am waiting for my official letter to schedule. Make sure to document EVERYTHING and call constantly. Ask for an insurance advocate so you only have to work with one person. Write down names, dates and times to every conversation and send everything by certified mail and get fax confirmations. You will get approved they just want to drag their tails and make you work for it. I am so glad your husband is doing better. My mom had open heart and it wasn't an easy thing to see her go thru and its my main motivation to get this surgery done and get healthy.

I'm glad I read this. I also have Aetna and went for a surgical consultation today. They told me I have to do a three month diet with monthly visits, but they never coached me about gaining or losing weight. I the idea that i was supposed to "fail" at dieting?

Also, I have to have blood work, and endoscopy, and a sleep study

My biggest issue is my bmi of 38. I have no co-morbidities. The only thing I have going for me is the fact that I had and removed lap band.

Not feeling to confident

I'm glad I read this. I also have Aetna and went for a surgical consultation today. They told me I have to do a three month diet with monthly visits, but they never coached me about gaining or losing weight. I the idea that i was supposed to "fail" at dieting?<br><br> Also, I have to have blood work, and endoscopy, and a sleep study<br> My biggest issue is my bmi of 38. I have no co-morbidities. The only thing I have going for me is the fact that I had and removed lap band.<br> Not feeling to confident

Hey Bruce, yeah they never coached me either. I had a lot going on during the 3 month visits. I had a gain over where I started. Soooo. My advice for the 3 month visits is to only lose a few pounds a month. As too not get too low.

I'm writing my appeal letter now. I'm really bummed out still.

Keeping my fingers crossed for you.

Good luck and keep me posted!

So ironic isn't it? You gain weight so they deny it when the reason for even having the surgery to begin with is because it's a last resort because you've tried every single thing else out there to lose the weight!

APPEAL for sure. If it is a covered procedure to begin with, then you have a good chance of winning the appeal given the circumstances. Good luck xx

So ironic isn't it? You gain weight so they deny it when the reason for even having the surgery to begin with is because it's a last resort because you've tried every single thing else out there to lose the weight!<br> APPEAL for sure. If it is a covered procedure to begin with, then you have a good chance of winning the appeal given the circumstances. Good luck xx

Seriously ironic. I have been struggling with my weight since I was 12. I remember my mom bringing to weight watcher at 12/13 years old. I have lost, gained probably over 1000 pounds since than.

I have my nutrionalist appt tomorrow just incase they deny my appeal. I would have to do 3 more months of supervised diet. It's not like I gained 50 pounds, it was under 10 pound gain while my husband was hospitalized and then even home. I have never gone through anything like that in my life. We just celebrated our 2 year anniversary of being married. I'm 33. I shouldn't have watched or gone thru this struggle so early in life, but is what it is!!

I'm definitely appealing. It's just my luck is what it feels like. I managed all my testing through out all that was going on with him and to be denied was a total slap in the face. BUT... God only gives us what we can handle right? This too shall pass...

Ahhhh!! Hahah oh well. Hopefully all will work out. Trying to stay postive!

After being denied cause of a weight gain over 6 months, Aetna does have the 3 month program. It's all I got left so I have been doing it. Not too hard in my first month I have lost 10 pounds. U won't be done till October. Sigh!!! But better late than never!! I can't imagine they would deny me for losing weight!!! Lol

I have to do a 3 month nut

I can't imagine they would deny me for losing weight!!! Lol

I lost about 40 pounds during my 3-month with Aetna. I was already losing when I started the process for the sleeve. The insurance coordinator at my surgeon's office said Aetna only uses the starting weight to determine BMI eligibility (mine was 42 when I started the 3-month and 39 at the end), so how much you lose during that three months...all the better. But she did emphasize that any weight gain from my initial weigh-in could get me denied by Aetna.

Edited July 25, 201412 yr by AlwaysVegas

Walter Lindstrom has a website in which he details the appeals process and options you have. Very interesting!

http://wlsappeals.com/how-we-help/

I have been doing the six month supervised diet as required by BS and have been challenged to even stay where I am. After taking diet pills for years to stay at 225 I developed a reaction to phentermine and could not take it anymore. After I got past the withdrawal period I started to try to at least maintain at 235. At my last appointment I was at 246. Last night, as I was taking my celexa, I remembered that about the same time I started exploring WLS, my dosage of celexa was increased and I changed from taking it only when I felt like I needed it to taking it everyday. Needless to say I cut back to my previous dosage and am going to ask my Dr about other options.

<p>Walter Lindstrom has a website in which he details the appeals process and options you have. Very interesting!</p> <p> </p> <p><span style="font-family:'Times New Roman', serif;font-size:14pt;"><a data-ipb='nomediaparse' href='http://wlsappeals.com/how-we-help/'>http://wlsappeals.com/how-we-help/</a></span></p>

Thank you, there is a lot of good stuff in this article. I hit a wall with my letter and needed to read this today. Thanks so much beaglelover.