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AETNA DENIAL

nomorefattypatty

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nomorefattypatty    329

nomorefattypatty
Posted

Ok, so I went through all the months of nutrition classes, blood work, stress test, EKG, and x-rays. I am revising from the sleeve to the bypass because of really bad acid reflux and a hiatal hernia. After Aetna kept giving me trouble I was losing all hope of getting approved. Yes, after all the work I did they said my appeal was DENIED! However, I received a letter in the mail on Friday that ordered Aetna to approve my surgery within 72 hours. Medicare had stepped in and said basically that Aetna is my fiduciary in the medical insurance and they are responsible for keeping me healthy. Due to the fact that bypass is proven to stop reflux Medicare overturned their decision and I am now on my way to getting a surgery date. I am praying that above all other things the bypass is good for that it just relieves my acid reflux and helps me loose another few pounds. I had my sleeve June of 2016 and I'm still doing good. I've gained about 25 lbs. back so I hope it helps me lose and I'm positive it will, but haha to Aetna and don't let these insurance companies dictate what happens with you're health. Stay vigilant and keep pressing forward to your weight loss goals. Thanks for listening.

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Panda333    276

Panda333
Posted

49 minutes ago, nomorefattypatty said:

Ok, so I went through all the months of nutrition classes, blood work, stress test, EKG, and x-rays. I am revising from the sleeve to the bypass because of really bad acid reflux and a hiatal hernia. After Aetna kept giving me trouble I was losing all hope of getting approved. Yes, after all the work I did they said my appeal was DENIED! However, I received a letter in the mail on Friday that ordered Aetna to approve my surgery within 72 hours. Medicare had stepped in and said basically that Aetna is my fiduciary in the medical insurance and they are responsible for keeping me healthy. Due to the fact that bypass is proven to stop reflux Medicare overturned their decision and I am now on my way to getting a surgery date. I am praying that above all other things the bypass is good for that it just relieves my acid reflux and helps me loose another few pounds. I had my sleeve June of 2016 and I'm still doing good. I've gained about 25 lbs. back so I hope it helps me lose and I'm positive it will, but haha to Aetna and don't let these insurance companies dictate what happens with you're health. Stay vigilant and keep pressing forward to your weight loss goals. Thanks for listening.

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Thank you for posting your story. Aetna also denied me after I had been pre-certified, received verification it was covered, completed the entire plan with my surgeon and spent $4500 on pre-op stuff. I was devastated and posted in another thread here. My doctors office actually said, come get your files and find another doctor. The patient advocate actually told me that. I had to summon all the strength I had. I complained to my doctors off, the actual surgeon, aetna, and my employer. it turns out that the person in the doctors office didn't submit my appeal properly and I assume didn't want to get in trouble and thought I would just walk away. Once they appealed I was approved in 24 hours. Good for you for staying positive and I agree, we do not let insurance companies, or even incompetent drs. office staff dictate our own health!!!!

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nomorefattypatty    329

nomorefattypatty
Posted

Thank you for posting your story. Aetna also denied me after I had been pre-certified, received verification it was covered, completed the entire plan with my surgeon and spent $4500 on pre-op stuff. I was devastated and posted in another thread here. My doctors office actually said, come get your files and find another doctor. The patient advocate actually told me that. I had to summon all the strength I had. I complained to my doctors off, the actual surgeon, aetna, and my employer. it turns out that the person in the doctors office didn't submit my appeal properly and I assume didn't want to get in trouble and thought I would just walk away. Once they appealed I was approved in 24 hours. Good for you for staying positive and I agree, we do not let insurance companies, or even incompetent drs. office staff dictate our own health!!!!
I think my doctor's office dropped the ball also. They screwed up the peer to peer conference and said they filed an appeal. Aetna says they weren't available for conference and they never did the peer to peer. They never even returned my phone calls. Finally I got pissed and went in there but it didn't help. I had the sleeve 3 years ago and that dr. was always on top of everything so I assumed that would be the case here. Not even close. I'm glad I kept on top of stuff, but getting approved by Medicare was a Godsend because I definitely prayed for it and that's when I got my approval. Thank you God for your devine intervention [emoji173]

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nomorefattypatty    329

nomorefattypatty
Posted

Finally, my surgery date is October 15th. I have to get a few tests done over because they were due again due to timing but finally my revision is going to get done. I'm praying for no more acid reflux. Keep you posted!

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Frustr8    7,886

Frustr8
Posted

Yeah Please let us know, we want to give YOU a Victory Cheer when it happens, and it's About Time!, at least that's my Point of View!

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Panda333    276

Panda333
Posted

10 hours ago, nomorefattypatty said:

Finally, my surgery date is October 15th. I have to get a few tests done over because they were due again due to timing but finally my revision is going to get done. I'm praying for no more acid reflux. Keep you posted!

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Congrats!! I am October !

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pssk    225

pssk
Posted

I’m your surgery twin on 10/15.

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kathymae    9

kathymae
Posted

I had revision from lapband to RNY.. My insurance approved me and I had the surgery.. I received a bill fo 6700.00 they paid for everything except the actual bypass. Wtf. Finally after 2 appeals and 6 months they paid.

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nomorefattypatty    329

nomorefattypatty
Posted

I had revision from lapband to RNY.. My insurance approved me and I had the surgery.. I received a bill fo 6700.00 they paid for everything except the actual bypass. Wtf. Finally after 2 appeals and 6 months they paid.
Sometimes you just have to give them a fight especially when they deserve it

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Go To Topic Listing Gastric Bypass Surgery Forums

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    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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