The good news, got sleeved on December 16th, including 2 hernia repairs. Doing good after I got off of protein shakes at two weeks. Had diarrhea for 9 days, developed a lactose intolerance.
Now the kicker. Got approval thru Aetna for the hernias and sleeve. The sleeve I felt was needed due to constant back pain and knee pain. And yes, lost 25 pounds already and only needing hydrocodone, once in last ten days, yea!
My sleeve was postponed from 7:30 a.m. to 5 p.m. Since the day previous and the day of surgery, had nothing to eat but a little water the previous day, I dropped below the bmi of 35. Hospital WOULD NOT allow sleeve to be done charged to insurance. I am in my gown in pre-op in tears because I felt I really needing this done. 1.2 pounds light, really. Dr. said no more openings the rest of year and would of cost me more if I reset after the first of year, due to deductions starting over. I was able to pay the out of pocket additional amount of $9,000 after two weeks earlier paying $3700 which should have covered my insurance deductible. I contacted Aetna after getting home and lady I talked to said that doesn't sound right. I am trying to get hospital to submit claim to insurance, but I know Dr. will be p.i.a. because he has gotten his cash money. ANY SUGGESTIONS or thoughts, please share! I had read before that once insurance approves that they don't care and hope you lose weight, to make the surgery easier. I know this is all the doing of the hospital and really is upsetting me.

Sent your receipts in to Aetna for a claim. Insurance will reimburse you or they should at least give you back some of your money

You need to fight this! Get a lawyer if you have to.

Hmmm....and unless you speak with the ins ppl you will not know if they also collected money from them in addition to what they took from you.

Talking with the hospital nurse/ filing person, no claim has been sent in yet, regarding the hospital stuff, but then again the last letter I got from Aetna, 12/30 said the sleeve and the 2nd day of hospital was approved for Dec. 16th. WTH how would they know I stayed a 2nd day if they didn:t file anything. Grrrrrrrrrr.I wish you 'smart' people were close so I could take ya'll with me! So the $3000 sleeve at the moment stands at $12,700. I might need bailsbond person on speed dial when I go there Tuesday. I am leaving my nice boy britches at the house.

I am just so sorry that they are dirty cheats! Get 'em!

I am just so sorry that they are dirty cheats! Get 'em!

lol, you bad, Thanks!

I was worried about the same thing and I was told my insurance only used our beginning weight b/c they wanted to see us losing and were not going to penalize us for it. Everything should have been approved prior to surgery day--this sounds way shady.

Thanks Steph, who is your Insurance. I told Cindy if surgery done at 7:30 a.m. as scheduled would of been fine, no done at 5:30 p.m. No drinking or eating two days, extra pee break got me. Official weight wrote down 256, needed to be 258. She pulls corporate policy out, I guess I need denial letter in hand

To clarify, and correct me if I am wrong, this has nothing to do with insurance. The hospital has not said your insurance will/will not pay (and you have proof you are approved). They are saying it is HOSPITAL policy that all clients under x BMI must self-pay.

That's a very strange policy, first off. Second, their own alterations to the schedule is what caused your problem. You were an adequate BMI upon entering the premises - it was their lack of prompt, adequate medical care (ie. Delayed) which resulted in a lowered BMI. In my estimation, that means the responsibility is theirs, not yours. And third, I think it could be argued that since you obviously have approval, they submitted to insurance in good faith with the intention of proceeding with the BMI listed in file - using an alternate BMI would seem to be fraud, as that is not what they represented to the insurance company.

Again - contract with insurance company means they must accept it if a patient has it. They do not get to pick and choose.

And no, I'm not a lawyer. I didn't even sleep at a Holiday Inn Express last night

To clarify, and correct me if I am wrong, this has nothing to do with insurance. The hospital has not said your insurance will/will not pay (and you have proof you are approved). They are saying it is HOSPITAL policy that all clients under x BMI must self-pay.

That's a very strange policy, first off. Second, their own alterations to the schedule is what caused your problem. You were an adequate BMI upon entering the premises - it was their lack of prompt, adequate medical care (ie. Delayed) which resulted in a lowered BMI. In my estimation, that means the responsibility is theirs, not yours. And third, I think it could be argued that since you obviously have approval, they submitted to insurance in good faith with the intention of proceeding with the BMI listed in file - using an alternate BMI would seem to be fraud, as that is not what they represented to the insurance company.

Again - contract with insurance company means they must accept it if a patient has it. They do not get to pick and choose.

And no, I'm not a lawyer. I didn't even sleep at a Holiday Inn Express last night

It appears the Hospital is smarter than I gave them credit for. When I called Aetna yesterday evening to talk with them, they are like no if ands or buts if bmi goes below 35 even with co morbities. Wasn't their fault or concern my surgery was delayed that day, not their fault I dropped 2 pounds below my 35 bmi. I feel where I am at now, to get Dr. and hospital to file and when I get the Aetna denial letter, to educate myself better on the process of filing an internal and or external appeal. Appears this hospital had dealt with the Hard hearted Aetna people before. And rightfully so, covering their _ss.

I got tired of arguing with my insurance, bit the bullet and paid for it myself. I think of it as a car payment for 3 years. In the whole scheme of things, I'd rather be healthy rather than riding around in a new Buick. Sometimes we have to deal with life on life's terms.

They should still file the claim. Just because the customer service rep has a cheat sheet that says not below 35 BMI does not mean that once the actual examiner reviews the claim and your medical history that is what the determination will be. The cheat sheets the CS reps rarely have every little detail.

I do find it odd they did not weigh you immediately at check-in. That was the first thing my facility did with me still dressed in street clothes. Heck if I got that run around I would have been borrowing hubby's winter coat to re-weigh with or had them recheck my height and slouched a bit.

Heck I used to be 5'4" in high school. I now measure at 5'3" 30 years later. It is common to lose height as you age.

They should still file the claim. Just because the customer service rep has a cheat sheet that says not below 35 BMI does not mean that once the actual examiner reviews the claim and your medical history that is what the determination will be. The cheat sheets the CS reps rarely have every little detail.

I do find it odd they did not weigh you immediately at check-in. That was the first thing my facility did with me still dressed in street clothes. Heck if I got that run around I would have been borrowing hubby's winter coat to re-weigh with or had them recheck my height and slouched a bit.

Heck I used to be 5'4" in high school. I now measure at 5'3" 30 years later. It is common to lose height as you age.

Thanks for that. The nurse allowed me to redress but Didn't realize my magic go home number was anything less than 258. I weighed 256.8.

I got tired of arguing with my insurance, bit the bullet and paid for it myself. I think of it as a car payment for 3 years. In the whole scheme of things, I'd rather be healthy rather than riding around in a new Buick. Sometimes we have to deal with life on life's terms.

Yea, I understand. When I started this journey, A surgeons office in Houston said no way for insurance. Talked to people in Victoria, Texas and they led me to a direction of hoop jumping and was approved. I had already borrowed the money and had put back for cash pay, so imagine the satisfaction of getting the approval letters. So when in pre-op in my gown when confronted with cash pay or no way, as you did, hell or high Water I needed the sleeve and got it. As Nikkidoc stated, just because a phone person says no, is no reason not to submit the claims.

Thanks all for support and good ideas. I went for my 27th day checkup and laugh cause they fussed at me for once again, losing too much weight! I said your fault just going for the ride! Anyway, both the Dr. and the Hospital have or are filing, and hopefully a compassionate examiner with Aetna ill review and approve.