MommyTawnie

I am over the moon excited. Surgery is soon but I am fine with that. As of now my surgery isn't going to cost us a penny!! I have had 2 surgeries this past year so my deductable and copay is met 100%. We change insurance in January so I have to get it before the 1st of the year.. No matter what I am stoked March to now is a long process.. Thanks for the wishes!!

Call insurance yourself and see what you can do on your end.. If you can submit everything then go for it.. If they only take it from the surgeons office then you have no choice but to wait..

I called today to check on the process of my paperwork, and the lady I talked to told me they have not recieved it in the precertification department yet.. Bummer I know, but then she went on to ask me if the doctors office knew there were 3 different ways to submit? Umm I don't know, but I will take the info and call them with it asap. Process number 1 Surgeons office can fax the paperwork to aetna it can take 3-4 days to reach the precert department. Process number 2 Surgeons office can fax the paperwork to there fast track number it can be approved as early as that same day.. Process number 3 Surgeons office can call in the info and it could be approved on the spot.. As soon as I hung up the phone I was calling the doctors office with the new info I had to offer. The lady that submits the paperwork actually answered the phone. I shared my new knowledge with her and she is going to resubmit to the fast track number!! I am soo excited I could have an actual surgery date as early as tomorrow!!!

You have to stay on top of Aetna once its sent to them.. I have a friend that had her surgery a year ago, and she called every other day for a week. Finally they approved her and she had the surgery. I am just hoping the fast track fax number actually pushes it through faster. It's suppose to take no more then a day to have it looked at and get an answer back. I have been on this journey since March.. I am ready to take the next step SURGERY!! I have sleep apnea which is considered a co-morbidity so that should help seal the deal with Aetna!! Thoughts and Prayers over the next few days..

All of my paperwork was submitted yesterday to insurance. I completed my 6 months on the 15th along with pych eval, and dietican consult. I had a sleep study done as well "sometimes aetna request one be done". I actually talked to a lady today through Aetna's precertification department that told me there are 2 different numbers paperwork can be submitted to. 1 number takes the paperwork through all of the process which can take up to 3-4 days. The other number is what they call the fast track number. It actually sends the paperwork through to the precertification number right then and can be approved that day or the next. I called the office back to see if they could re-fax it to the fast track number. I am ready to get this going.. I have never been this excited about anything other then the birth of my children, and my wedding of course.. This is a new beginning for me!! Let me know how long it takes for yours to go through!!

Hello all I am Tayna. I am a 26 year old mother of 2. I stand 5'3 and weigh in at 237 right now. My BMI is at 42 1/2 is what the nurse told me yesterday. I started my journey back in June for a 3 month weigh in. Only to find out at the end of the 3 months I was suppose to be seeing an exercise therapist as well as a dietician for the 3 months charting if I was doing it that way. Knowing that I would have to start over if I wanted to do the 3 months I went ahead and decided to do the 6 months of consecutive charting. I have 2 months left and I am feeling more more stressed over the whole thing. My biggest fear is being denied for the surgery through insurance. I don't have the money to pay for surgery out of pocket, and insurance covers at 80% leaving hubby and I paying the other 20% which is more in a price range we can afford. I have done my pych evaluation and just had my meeting with the dietician yesterday. The only thing I have left is these last 2 months. Out of experience did you have problems with your insurance approving for surgery, or did it go pretty quickly?? :thumbup::confused::confused:

6 months finally finished!! I had my last weigh in on Monday and managed to loose 1 lb over the past month. I called the surgeons office and all they are waiting on is the last months notes from the doctor and my 2 year weight history.. I can't believe it is finally time to submit.. It feels like it has taken forever to get here, but now that I am here I am pleased that I have made it this far.. I am hoping to have surgery on the 10th or 17th of December!! Depends on how long it takes Aetna to approve.. Thoughts and prayers while I wait..

I started my 6 month charting back in June. Tomorrow is my last weigh in and I am totally terrified to see what the scales say. I lost weight the first 4 months and last month had a 3lb gain. I was told not to worry about it to much because different clothing and different scales can make a world of difference when weight is involved. I have done nothing but freak out about this last weigh in. I was told if I had any weight gain they would see it as me not trying and not approve the surgery. I have busted my butt to loose weight but it's no longer coming off. Infact I am gaining weight now. It never fails I loose loose loose and then it all comes back.. It's very frustrating to know that I am putting in an hour a day at the gym and watching what I eat, but the weight is staying. Is this going to affect my approval? Please anyone tell me your experience with insurance and getting approved..

Sorry all I have not been on in a bit.. I am going for last weigh in tomorrow!! YAY!!!!!!!!! Really looking forward to getting this one out of the way.. I was diagnosed with Sleep Apnea which I was told is a co-morbidity which should help insure there approval. I do hope so.. My insurance plan is POP through Aetna and they cover 2 nights with the sleeve or bi-pass.. Wish me luck all hopeing to have surgery the first part of December would LOVE to be able to enjoy some soft mushy food for Christmas..

A 6 month supervised diet is what most insurance companies require if you do not have any co-morbidities. With them it's usually a 3 month supervised diet.. Count your blessings no matter how unfair it seems.. I know a lady that has had BCBS throughout her whole career as a teacher, and now that she is 64 and a year into retirement they won't cover the surgery because she is no longer an employee of the state. She is greatful however that come February she switches to Medicare because she turns 65. My insurance requires a 6 month supervised diet, and I am a little over 2 weeks away from completing it YaY!!! And don't be surprised if they ask for more then just a supervised diet. I have had x-rays, blood work, a pych eval, 1 meeting with a dietician, and a sleep study as well as an EKG. With both sleep studies my blood pressure was elevated so I am hoping that makes it's way into my chart as well.. The more I can add to my charts that show me leading toward more health issues the more it goes toward me getting approved. As unfair or as Sucky as it sounds most everyone on here as had to go through the dieting and exercising to get approved.. Best of Luck to You on you Journey!!

I worry about the same situation, but I look at it as a positive thing. If other people are paying more attention won't that make hubby pay more attention? I was 130lbs and a size 6-8 when we started dating. Almost 6 years and 2 kids later I am 237lbs and a size 18-20.. I have told him that when the weight is gone surely the sex drive will show back up, and it would be better for us both. LoL My marriage is solid, and I know with weight loss things change, but I think if it changes it will be for the better.. Quick question you have Aetna did you submit on the 1st if so how quickly did they approve? I finish my 6 months in November and then submit!!!

I just had my sleep study done, and recieved the results today. I have tested positive for Sleep Apnea, and have been scheduled to be fitted for a c-pap mask/machine. I want to believe that this is a sure fire thing for my surgery, but I'm still not convinced.. If I have tested positive is this considered a co-morbidity? If not is it still a good reason for insurance to approve me for surgery? I finish out my 6 months on the 15th, and I am over the moon with excitement to think this could really happen, but in the back of my mind I keep telling myself not to get to excited because they could deny me, and given our finance situation we couldn't afford the surgery if it was pushed to the start of the new year. As of now I have reached my out of pocket and the surgery would be covered 100%. If you tested positive for sleep apnea did insurance approve first try? Or did they request more test?

I don't even have an appoinment for the fitting and sleep over with the machine until the 1st of December.. Hopefully by then I will be approved by insurance for the surgery.. I hardly get any sleep at all do to the tossing and turning which I thought was caused by the pain I feel in my leg, but it has started to affect my days. I wake up tired and stay tired throughout the day. If I'm approved for surgery and I start loosing weight will I still need to be fitted for the c-pap mask/machine?

The check list is the most important thing in starting on the journey with insurance.. With out it you may miss something, and not be approved. They usually want to make sure your not gaining weight while on the diet, and see that you are making the effort to loose or maintain whichever you are able to do. Through out my 6 months I was loosing weight till I hit the 5th month. I had a 3 pound weight gain even though I was on the same 12-1500 calorie diet with 30 minutes of exercise a day. I do hope it doesn't affect my approval, but it's like I've told every doctor that I have seen I loose and no matter what I do it starts coming back. I am just pushing myself extra extra hard over the next couple of weeks to insure I maintain atleast.. Best of Luck!!

I am assuming they are referring to outside staples.. The staples that close up your stomach will be covered with stitching as well. Your body will in time "consume" the staples/stitching. They will never be removed..

I finish up my 6 months on the 15th and I couldn't be any happier. During the 6 months the doctor will put you on a diet and exercise regimin. During the first visit they will weigh you and chart your BMI as well as blood pressure, temp, ox stats, and everything else they do in a regular visit. You will need a Pych Eval, meet with a Dietician and with my insurance "Aetna" have a sleep study. They may also ask for x-rays, blood work, and a recent EKG if you have no co-morbidities. Even with they still may require all the above.. Call your insurance and find out if there is a website that explains what they expect from you during the 6 months. Make sure you understand everything clearly and if not then be sure to ask LOTS of questions.. Best of Luck to You on You Journey!!!

This is what I was told after I had completed 3 months with my pcp. During the 3 months you have to meet with 3 people. 1: your pcp for the charting of the weight 2: you have to meet with a dietician all 3 months to log the diet/meal modification she suggest and 3: an exercise professional that can log the exercise program he/she put you on for the 3 months.. The first surgeon I met with seemed to really know what he was doing and he was highly praised for his practice, but the office failed to inform me that I had to meet with all 3 people every month during charting.. I did my pysch eval I did the "4" months charting and I did the dietician consult just to be told I had done it wrong. However because I already had 4 months of charting under my belt I am going to finish out the 6 consecutive months with my pcp.. He will be the only one charting my weight, diet and exercise program. I am also fixing to have a sleep study done for Aetna.. They have not told me it is required, but a friend of ours with the same company had to have one at Aetna's request, because her being over weight wasn't really grounds for surgery. Aetna has a lot of loops you have to jump through to get what you want at the end, but it is well worth it..

If you feel you need a consult with a weight loss surgeon then go for it.. It is your body and you know what you need.. However a BMI of 26 is really close to a normal BMI.. I know with our insurance company "Aetna" a BMI with co-morbidities is the lowest they will take when covering weight loss surgery. If you have no co-morbidities a BMI of 40 or higher is what they look for.. I am 5'3 and weigh in at 237 my BMI on the 27th was at 42.. Talk to you doctor or talk to a surgeon and see what he/she has to say. They may recommend you see a dietician and meet with a personal trainer or something.. Oh and let me add this in a BMI of 17-25 is where most women should be.. If you are at 25 then you are still considered normal by most doctors.

Oh WOW 1 week and that's after switching insurance companies.. Gives me more hope then anyone will ever know.. I am excited for the 18th to get here.. Then I am down to 1 month left on my 6 months journey leading up to surgery.. I am smiling inside and telling myself everything is going to work out..

They haven't mentioned anything about a pulmonary clearance, all of my testing was done for a routine yearly exam. We have a friend that had her surgery last year, and she said the only test/study she needed was a sleep study. She was shocked to find out that she had a mild case of Sleep Apnea. Her surgery was approved within 2 weeks of the results being sent to insurance.. I meet with my pcp on the 18th at which time I am going to request a sleep study just to see if there are any other issues I am dealing with "plus it will be taken care of if insurance request one". As of right now I am constantly tired, and have not gotten a good nights rest in a very long time. He wanted me to under go a sleep study 2 years ago, but my son was a year old at the time and I was the care taker at night when he would wake up.. Now he sleeps through the night and I feel better about sleeping away from them over night.

Thanks all I met with the surgeon and the check list they provided covered more details for 3 months and the 6 month charting. My PCP is on top of everything. He has had 2 other patients go through him for the charting and both were approved with the first try.. I am excited to get through these next 2 months. All though it will be pushing it for approval and surgery I am confidant that I will be approved after talking to friends with the same company/insurance, and reading post on here. I am really looking forward to the new journey. Even though it is taking a bit longer then I had hoped the way things are looking now I will have the surgery before the end of the year I have been instructed to call atleast once every 3-4 days to see where I am at in the approval process, and to provide any information they may need to go with it.. I had my yearly exam back in August it included all the blood work, EKG as well as x-rays. Everything looked good and he was very confident that I would make a good canidate for the surgery. Fingers crossed it goes as smoothly for me as it has for others...