Hi everyone.... Im new. My name is Jennifer and i have started my whole list of doctors appointments for surgery. My surgery date is June 10th and I am sooo excited.

I have an issue though and I'm soooo nervous I wont be approved. It appears I am 36 on the BMI chart. I am 5'7 and 234. 110 it says overweight for my height . I am going through a great doctor in NJ who I hear rave reviews about but, for starters I was crossing my fingers I had sleep apnea lol cause that could have been my comorbidity for approval but, turns out I am a 5 I still have more docs and tests to do but, wanted to know if anyone else had Aetna hmo in NJ who is similar to me on the scale? Also, if they got approved for surgery with Aetna... i was told they are the hardest to get approval with... I will be so let down if I go threw all of this and thwy shoot me down. Any adivise or anything anyone can give i would love to hear it.... thank you

Sent from my SM-N910P using the BariatricPal App

Received message with the net weight gain photo but doing more research and found out by talking with dr office today and they said I did not gain , I actually lost weight start 6/2015 240lb to 9/2015 at 239.5 so I'm not sure what is going on. Maybe Bec The dr office submitted my paperwork to insurance comp two weeks after the 6 month deadline to schedule my surgery , I have no idea.

Sent from my iPhone using the BariatricPal App

This is BS! Anything to avoid paying! Fight!

Sent from my KFFOWI using the BariatricPal App

What exactly did your denial letter say?

Yes I will fight.

Sent from my iPhone using the BariatricPal App

I hired lindstrom advocacy and they are fighting with this with me

Sent from my iPhone using the BariatricPal App

I also used lindstrom. Had to go through to the external appeal but won in the end. Don't give up

Sent from my iPhone using the BariatricPal App

I hope you can read it !

Sent from my iPhone using the BariatricPal App

@@dede0314 thank you.

Sent from my iPhone using the BariatricPal App

@@KristenLe thanks

Sent from my iPhone using the BariatricPal App

Oh and by the way , Aetna (case manager) said I am only allowed one level appeal and external review is not allowed under my plan

So I did a little digging and pulled up my benefits and researched , then called Aetna and was told a different story.

I am allowed an external appeal and my denial letter indicate that I am allowed not only one but two appeals plus an external review. This is unbelievable !!!!

Sent from my iPhone using the BariatricPal App

Insurance companies expect your monthly premiums on time but they surely put you through hell to have them pay for something that is covered under your benefit plan.

Sent from my iPhone using the BariatricPal App

Wow! My doctor's office told me that with Aetna weight gain is a huge deal. Even half a pound would get you denied. I was recently told that the time frame is a huge deal too. I was told I had to schedule appts 31-35 days apart, including weekends. If you go out of those date ranges, they will require you to do the 6 months instead of 3.

On another forum, I saw where a lady gained and Aetna didn't deny or approve her, they just made her do an extra 2 months and she had to lose weight, not gain or maintain.

Sent from my SM-G930V using the BariatricPal App

ImageUploadedByBariatricPal1469662552.370969.jpg

Sent from my iPhone using the BariatricPal App

I hope you can read it !

Sent from my iPhone using the BariatricPal App

@@dede0314 thank you.

Sent from my iPhone using the BariatricPal App

@@KristenLe thanks

Sent from my iPhone using the BariatricPal App

Looks like you were denied solely because you gained weight. It says you don't meet both criteria. I'm assuming you meet the BMI criteria, but because you gained weight, you don't meet the 2nd criteria.

Sent from my SM-G930V using the BariatricPal App

Oh wow !!! Dang it , I guess I will have to start over

Sent from my iPhone using the BariatricPal App

But start weight was 240 and end weight 239. So I lost a little.

Sent from my iPhone using the BariatricPal App

From the denial letter it looks like there are two reasons you were denied

I just got off the phone with my insurance, apparently they are not covering the surgeon appointments (SERIOUSLY) uggh anyway I asked how long it takes once we send in the paperwork for approval, they told be 20 business days.

20 business days - that is another month. All my pre-op stuff (NUT, Cardio and Pulmonary) are finished by September 23rd.

I hope I am able to get this surgery done this year. but a month just for approvals is already putting me at November.

From the denial letter it looks like there are two reasons you were denied

You have to meet both requirements, but she wouldn't meet both if she didn't meet one.

Sent from my SM-G930V using the BariatricPal App

I was denied from weight gain and my denial letter only had one reason... The other seems like either the BMI criteria wasn't met or the doctor didn't send any records that she has been overweight for a period of time

But I would call the insurance company to clear it up...