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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. [emoji171]

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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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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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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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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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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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I’m your surgery twin on 10/15.

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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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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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    • LeighaTR

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      1. Phil Penn

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    • 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!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

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    • Alisa_S

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      · 1 reply
      1. LeighaTR

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