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Aetna H. M. O. So Cal - Advice

Hi all, I'm new to the sight and am looking for anybody who has Aetna H. M. O. And possibly from SoCal. I have my primary care physician on board, met with the NUT and she approved, had my psych evaluation and she approved, I am 36 and 225 lbs. (at my heaviest I was 245lbs.) I am pre-diabetic and have high cholesterol (not on meds for either at this time, but have been in the past). I had my sleep study and do not need the cpap machine but was told that when I hit the REM sleep in the early morning hours I stop breathing 8 x's an hour and to solve that I will need to lose weight. So my question is this, for anybody who has this insurance, how hard was it for approval? Has anybody had a similar situation as me? I am currently waiting to hear from my Doc to set up the appointment with the surgeon.... So any advice while I'm playing the waiting game would be very much appreciated! Thanks!

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I know exactly how you feel! Even though I've had my surgery now, it's only been 4 weeks tomorrow. Still so new, exciting and in such a time of learning and lifestyle change.

I haven't regretted it once. I've had no moments of panic or anything like that, just excitement over where I'll be 1 month, 3 months, 6 months and on from now. A slimmer healthier person.

I truly couldn't be happier for you. Why do long to see surgeon? Who did you already meet with to get approved?

  • Author

I had to do everything through my pcp to get approved, then once I'm approved I get to see my surgeon. It's rules of the a aetna H. M. O. I really was hoping once I was approved I would get to see him asap because I was trying to get through the brunt of the change before my busy season at work started, but I guess they just didn't have any openings till then. They did say they would call me if there was a cancellation so as much as I don't want somebody else's dream to get crushed I am keeping my fingers crossed that they will get a cancellation soon and I will be able to get in there.

  • Author

Since u are 4 weeks out now, maybe u could answer some questions. Do u feel somewhat normal now? How long does it take before u feel like u could go sight seeing or just getting active. Has it been hard to get ur eating regimen back in order? I have family coming to visit that I haven't seen in 2 years and they will be here at the beginning of May, end of April. So I just was wondering about how much time I will need after the surgery to be able to enjoy some of the days with them.

Call and make sure your Aetna plan doesn't require the 90 day weight management plan ASAP. Found out mine did weeks after I got started because they missed it and didn't disclose that info up front.

If they do maybe your PCP or the WL clinic can give you a dietician or whatever they do now why your waiting to see the surgeon, that's what I did. Being pre-approved doesn't eliminate the steps you have to finish before surgery day. Make sure to ask them questions. Especially the weight management program one because of time involved.

Hope you don't have it, I don't know if all Aetna rules the same.

I was getting around well without much abdominal pain in week but still had to be careful with the lower left. You're walking well, but not doing a lot. This is an invasive draining surgery on your body which is why many doctors suggest at least 2 weeks preferably 3 weeks before even returning to work.

As for eating, that takes time! At 4 weeks I'm adding solids but it's slowly and I haven't gotten sick, but I've been close and I've learned you have to progress slowly.

I feel great and have actually felt pretty great from the beginning. However, you're overnight taking away everything but liquids/protein ( and in moderation ) from your body after a surgery, so you'll be tired and you can't be sure exactly how you'll react.

That being said it has been easier that I expected. But, I have followed every rule/instruction!! I have gotten in my Water, my Protein and my Vitamins from day one.

  • Author

Thank you so much for the advice! I am going to check on that today. I know people who have gotten this done but haven't really followed the rules, and I've seen the consequences, so I have it in my head already that from the get go I am following the rules to a T!! I don't want to fail at this once in a lifetime opportunity for myself and I want to take full advantage of what the doctors know to be successful! I think I will just have to go with the flow and if my body just isn't up for walking around sightseeing with my family then they will just have to enjoy the time we get to hang out not running all around, lol!! I am keeping my fingers crossed that they will call me because of a cancellation!!

  • 4 weeks later...
  • Author

Got my approval from my insurance company today!! As long as all goes well with my preops I should be getting sleeved on March 31st!!! So happy, grateful, blessed and excited to be starting this new chapter in my life!!

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