6 months hell and Aetna said NO-devastated

whosyadaddy · October 23, 2007

you SHOULD go to obeistylaw!!! I mean it!! I think you would definatley get it approved.

Chris61 · October 24, 2007

Here is another thing to look at, make sure that they have all the information. Ask the doctors office to mail it all and have them sign for it. I was approved within 2 weeks of them sending it in. They sent my wife at the same time and never really found out what happen but the doctors office resent all the stuff and was approved within 2 hours after complaining. Good Luck.

Chris

RxTracy · October 25, 2007

I wouldn't give up. Keep trying. Things happen for a reason. I applied several years ago with Aetna for GBP and at that time they didn't cover AGB at all. Aetna denied me on application for GBP and twice on appeal. I am self pay now for AGB and so happy that I didn't get approved for the GBP. Things happen for a reason. Get the legal help as suggested, max out the student loans, borrow against your 401K, do whatever you have to to save your life and save the mother of your kids and the wife for your husband. Good luck.

mmcbelle · October 25, 2007

I haven't posted since 9-11. I've been punched in the gut. I worked HARD for 6 months to do everything that Aetna required of me to have the surgery, and they still denied me. ... What do I do????:cry

Hi aubrie,

Don't give up. Your feelings are so valid and I understand your emotions.

I hope my story will help. It took 18 months for CIGNA to approve me and I suffered two denials in that time. The first denial was very much like your denial. My Dr. did not provide exactly what they wanted and I visited the Dr. for sickness in the same visit, so within thier rules for the policy I was denied after my six moth extravganza, including two physche evaluations, digging up five years of medical history, having many tests, being diagnosed with sleep anea, etc., etc., etc.

After the first denail, I was devistated. Had I just wasted six months of my time and copays? Did the universe hate me? Was CIGNA the anti Christ? Finally in a crying lump of emotions, I called my brother (12 years my younger). I told him what happened. He said, "You have to answer two things...Do you really want this surgery? Do you want insurance to pay for it?" My all out balling slowed to wimpering. I actually thought about what he had said and asked myself the questions. The final answer was yes to both. So I had some things to do.

I decided to redo the six month diet monitoring with AIGB. They specialize in helping individuals getting approved for lap band. The second denial was after the second six months of Dr. visits. Again CIGNA denied for the same exact reason (they did not bother to review the paperwork, just stamped it as unapproved). My case worker from lap band solutions got a supervisor on the phone and got it verbally approved about one week later. Then CIGNA refused to send an approvel letter to my surgeon (my surgeons office worked on this part), but they finally did send written approval of coverage.

At the time, it seemed an awful experience. It seemed everything was agianst me. Now I can look back and see that I needed the 18 months to do some of the headwork. I had childhood issues that needed addressing. I needed to get prepared for this life changing experience. I did not think this at the time, but now I am thankful for the time I had to prepare.

Hang in there. You deserve this, but it may take more time than you anticipated.

My advice is to take a multi pronged approach. Get someone like lap band solutions to take on your case to work with a clinic where they specialize in getting lap band approved. Be prepared that you may have to repeat some of what you had to do over the last six months. Also go through the appeals process. Do all the things you can to get this...if it is what you really want (I think it is from what you have been through so far).

Was it worth 18 months to be three months post op today...not just yes, but #$@% YES. You are worth it, hang in there and do what you have to do.

Your DH sounds like a very supportive partner. Very good to have during this process.

Good luck to you and let us know how you are doing and what the progress is.

Good luck,

MMT

aubrie · October 25, 2007

MMCBELLE,

Wow, what a kind and supportive post. Thank you and all the other bandsters for their support!! It's so nice to know that you have someone in your corner routing for you. I jsut discovered that my surgeon's office staff sent all my appeal papers to the wrong place. So I have to have them resend the appeal. It just never ends.

Actually, this is the 3rd time I'm doing the 6 month diet thing. I got so frustrated and depressed that nothing worked, I basically gave up afterward. Then, I waited to long to have it count for Aetna. This is the first time I stuck through it to the end and filed my paperwork immediately afterward, regardless of my success. This denial thing was another reason I was reluctant to apply the other two times I did this, and I'll be damned if I wasn't right.

Yes, my DH is supportive of the surgery. He wasn't at first, because he was only familiar with the bypass. He didn't like that idea. His cousin had it done, and wasn't successful at all. He lost a good amount of weight initially, but ended up grazing 24/7 and gained most of it back.

So I wait. and wait. and wait. And wait some more. I started this whole process a year ago. Started the diet in January. Tuned in my papers the first of July. We'll see. Thanks again for encouraging me. My knee jerk reaction is to just give up and accept being obese. I wasn't always big. I still dream about myself as thin, even though I gained all this weight 17 years ago. I'm 48 and 252 lbs. At age 30 after having two kids, I was 128. Within 18 months, for absolutely no reason in the world, I weighed 185. I've gained steadily ever since. Sucks.