Rekeca

Thank you for your insight cheri and thanks for the website.

Thanks for your good thoughts. I haven't asked the Dr to move on to the next steps but I am pretty sure we are getting to that point next.

I am so frustrated. For one I have very unpredictible. For instance, my menstral came on on april 23rd, May 17th, June 12th and July 25th. So its like my menstral comes on every 24-25 days except the last one was about 43 days. I am currently taking clomid 50mg and started in May. The meds worked in May with getting me to ovulate along with the ovidrel but didn't result in a pregnancy. The meds didn't work in June because when I went in for my 13 day ultrasound. I didn't have any folicles. So for this month they increased my to 100mg & I went in on 08/06 for my 13 day ultrasound and I had a very small immature follicle so they told me to come back on 08/9 to see if it had matured. I went in and they said it was actually smaller than it was on Monday. The dr so the look on my face and he hurried and asked if I had intercourse anytime between monday 08/06 and thursday 08/9 and I told him yes. He said well maybe it took that is why its smaller. Yea right......... So the next course of action if I don't get a BFP around the 34th day then they will increase the meds again and also start me on metformin. I feel like time is running out for me I am 39 and my husband is 41. So time is of the essence for me. Sorry so long. I am just frustrated and husband keeps saying so how long are we going to go thru this? I tell him I don't know but I don't know if he is in it for the long haul and all of the ups and downs that comes with it.

Hey Caroina, Thanks for sharing your story. I am from N.C So I know what you mean about the barbeque. I love the eastern Barbeque as well. Yummy. Good luck on your surgery.

Samantha, I already re-faxed the psych eval. I also have a current bmi of 40. I have diabetes, high blood pressure,PCOS, high blood pressure and infertility. So I meet the requirements. I just feel like I am being given the run around. I called and asked why I still have to go before the committee when you have the information, hell they had the information from the beginning. They still advise I have to go through the appeal. Its just frustrating.

I hadn't thought of asking my Dr. especially since this particular office don't help with appeals. However its worth a try to call and see.

I can't afford a lawyer nor do I know one that would be willing to speak on my behalf. I was a little intimidated and still is as a matter of fact, however I feel like I am fighting for my life and I will go in and with everthing I have in me. I believe in my father and he said ask and you shall receive. I know this surgery is the right thing for me and I have met all of their requirments so I am believing that I will prevail. Aetna has given me the run around since I submitted my paperwork. I am usually not a fighter but I feel so strongly that this surgery is right for me and it is what I need to get my health back so I am going to fight until the end.

I have been denied by Aetna for VSG. First because they stated I didn't meet the criteria of weightloss. However, I appealed and proved that I do meed the medical criteria however, they came back with a second denial because they say that I didn't meet psych clearance. Which was untrue. I faxed in the pysch clearance but now they want to do a Level II appeal committee tele - conference. I can choose to phone in and state my case to an unknown board I will be given 15 minutes to do this. Then I will be asked to leave the call where they will deliberate without me and send me a letter with their decision within 5 business days. They also state that I can have a lawyer present it I want to. WTF. Does anybody have any experience with this? What should I expect?

Thank you for the kind words

I just have to vent somewhere. I wish I wasn't at work so I could scream to the top of my lungs. I am so mad right now. I submitted my information to Aetna on May 11th. They promptly denied me stating that I didn't meet the weight criteria for two years. I submitted an appeal on 05/27/11 and showed that I met the criteria. So I just happened to call Aetna today just to check on the appeal. I wasn't expecting anything because they said it would take 30 days. To my surprise they had already denied my appeal, & get this, the appeal was not denied for what it was denied for the first time. This time they claim that I didn't get psych clearance. THAT's A LIE, I told the rep (It just slipped out of my mouth). So she claim I have to do a second level appeal. I said for what the info has already been submitted and I was cleared. I said let me speak with someone in appeals so I can let them know that they have the info. They don't accept phone calls. WTF. I am pissed. I feel like they are giving me the run around So I called my surgeons office and called the therapist to make sure I was cleared and that the info was submitted the first time which it was. I just want to take my fist and pound the top of the appealers head. Aetna couldnt even tell me how long a second level appeal takes. I am so MAD. So now I am going to fax my clearance to Aetna my self. I don't trust them. they are evil. Can't you tell I am mad...Any way thanks for letting me vent.......

I submitted my paper work on May 11th and had my answer by May 17th. Denied of course. I had to do the 6 months pre-op diet as well.

Thanks for all of the wealth of information. I will be using it in writing my appeals letter.

Thanks for the pat on the back and thanks Junior Guru for the blog on appeals

In an earlier post I told you guys that I was denied. So I called my Surgeons office and spoke with the surgery coordinator so that she can do the appeal for me and she stated that their office don't do appeals. WTH. I have never heard of this before. She said that I would have to call them my self. OK. I can do this but now I don't know where to start. I need help writing an appeals letter. Is there one out here that can help. I was denied beciase I wasn't over the 35 BMI with two co morbitities for about 6 months with in a two year time span. I lost 40 pounds but they can see that I gained it right back and then some. I have always been overweight. Please I need some guidance. I don't know where to start.

So I got the letter from my insurance(AETNA) yesterday stating that I was denied. I was a little disappointed but surprisingly not upset. I felt like the denial was just a road block because I am destined to have this surgery. I was denied because they stated that I wasn't obese for the last two years. It just so happens that last year I lost about 40 pounds which put me under the 35BMI with two comorbities. I kind of figured that, but I hope that they would have seen that I promptly gained it all back and then some. (I guess not). I have been overweight for the longest time. Since back in high school and problem even middle school, I just chose to try to lose weight at the wrong time. My question is has anyone had this issue, appealed your insurance and won? Are their any good appeal letters out their? I am determined to get this surgery. I have jumped through all of the hoops they have required and paid ump teen dollars for all the testing and office visits that they require, so I am not going out with out a fight. Any suggestions anyone.