giftoflife
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want you to jump through and he's determined to get this approved for me. If it is approved, then it seems like I would be able to have the surgery within the next two weeks.
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Hey Khy,
I am still in the process of getting the surgery approved, but things are looking up. My surgeon did what they call a "peer to peer" where he speaks with the Medical Director of Aetna and pleeds my case and as to why he feels I should have the surgery. Aetna said they needed a letter from my gp, which is what is being done. It seems that my gp knows what hurdles the ...
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Was reading your post... How did it work out for you? Did Aetna go ahead and approve? I am in kinda the same situation as you. Healthy but BMI over 40.
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I was exactly 1 week away from my gastric sleeve surgery date and the bariatric center called me and said my insurance (Aetna QPOS) denied me the procedure. They have a ton of requirements to qualify for surgery, 1 being 6 months of doctor visits, 2 years of weight loss history and what they told me was that because I was not over 40 bmi for the past 2 years that it wouldn't be approved. What a punch in the gut that was. Of course, my surgeon is out of the country on vacation so he can not call prior to next week - so surgery put on hold. I called the insurance company and they said the doctor had to do a "peer to peer" consultation, the surgeon and the medical director at Aetna. This is a phone call to explain why the surgeon thinks I should have the surgery. If all goes well (please cross your fingers for me) then they will be able to reschedule my surgery asap. If not - then the appeal process begins. I am hoping this is not the case, but I can only play this by ear for now. I never knew that being a "healthy" obese person could work against you, but since I don't have any co-morbid problems like diabetes or high blood pressure - they have to hope that my history with PCOS (Polycyctic ovaries) or a family history of high blood pressure and diabetes will work to my advantage. If you pray - could you send one up for me??? Thanks!
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I was exactly 1 week away from my gastric sleeve surgery date and the bariatric center called me and said my insurance (Aetna QPOS) denied me the procedure. They have a ton of requirements to qualify for surgery, 1 being 6 months of doctor visits, 2 years of weight loss history and what they told me was that because I was not over 40 bmi for the past 2 years that it wouldn't be approved. What a punch in the gut that was. Of course, my surgeon is out of the country on vacation so he can not call prior to next week - so surgery put on hold. I called the insurance company and they said the doctor had to do a "peer to peer" consultation, the surgeon and the medical director at Aetna. This is a phone call to explain why the surgeon thinks I should have the surgery. If all goes well (please cross your fingers for me) then they will be able to reschedule my surgery asap. If not - then the appeal process begins. I am hoping this is not the case, but I can only play this by ear for now. I never knew that being a "healthy" obese person could work against you, but since I don't have any co-morbid problems like diabetes or high blood pressure - they have to hope that my history with PCOS (Polycyctic ovaries) or a family history of high blood pressure and diabetes will work to my advantage. If you pray - could you send one up for me??? Thanks!
