sueob1968

Awesome.....congrats....when is your date?

Bella, I am sorry, my response wasn't complete. I had decided to pay out of pocket as I had done everything required from Aetna. I did 'self pay' but kept working thru Lindstrom Advocacy, and after all appeals were denied, it went to an independent board, who approved it, so Aetna has to pay. I am now working with the surgeon and hospital, so they can submit the claims and I will be reimbursed. Apparently, they have 90 days from date of surgery to submit charges. I don't necessarily recommend risking it, but I needed to move forward on this. Either way, I had decided to have the surgery. I feel blessed that I will get my money back. I have about a month to get this resolved. All the billing offices have been helpful in submitting the claim now. If I can answer any questions, please let me know. It is so disappointing when you get a denial! For me, it was getting easier, when the 3rd denial came in. I had already convinced myself, I was making the right choice! I was elated when the independent board finally approved me. Don't give up if this is the right choice for you!

Bella, I was denied 3 times by Aetna. I was so disappointed. I contacted LINDSTROM OBESITY ADVOCACY, and they got involved. After all appeals, it was approved by the independent review. They do charge for their services, but I believe they have an 80% win rate. I had made the decision to pay out of pocket, but ultimately I was approved. Kelley Brown Lindstrom was very helpful, and not pushy at all. It is something to consider. Hope this helps. I know how hard it is to be denied....

I questioned if I really had anything done. You'll know for sure in time. Enjoy the journey.

You could set break time, and take 10 minute walks, 3 or so times a day. Do stairs as much as possible. Every bit of effort will help and as you feel better, you will continue to make the effort. You need to put yourself first. A few minutes won't put you that far behind. Maybe get an ear piece for conf. calls and lift hand weights? you have to think "outside the box". Good luck-you can do it!

I am working on second appeal with Lindstrom OA.

I was denied twice so far. I have asked Lindstrom Obesity to assist. Hoping it will be approved. If not..self pay. Good luck. Don't lose hope..seems Aetna approves a lot of people without denial...but if you look, they deny a lot too,

I asked and they told me there wasn't. They should! It's hard to,be patient! hang in there.

Thank you. I did contact them and they were more reasonable($) than I expected....I will keep my fingers crossed?

BMI has been above 30, but not 35.... I was above 35 when I started seeing a weight mgmt specialist. he is a medical doctor.

That's a thought. How much does the lawyer charge?

I have AETNA insurance. After 2 1/2 weeks of waiting on an answer, I was denied. Apparently, I haven't been over 35 BMI long enough. I have only been below, with the help of my PC who specializes in weight management. I have had 1-2 visits with him per month for 4 years. I have been over 30-35 BMI for YEARS (since I was a pre-teen.)My PC office sent 70 pages of documentation. I have his support for the Sleeve. I am devastated that I was denied. So, I did get a call from a patient advocate. What will they do for me? Do I have any chance of getting approved, or do I need to stay at my high weight for 2 years? It just doesn't seem right that I have worked hard, but not had much success, and now my alternative is to be unhappy and unhealthy for 2 more years, so the insurance company will pay for this. Thoughts and ideas welcome

Thank you for the suggestion. I am not sure what I will do. How is 'after care' handled if you had in MX?

I hope you get approved. Please keep posting...so I know...or email me. I wonder if your low weight was submitted. Hopefully, it wasn't, so it won't be denied...for the little bit of time you were down.

I submitted at 35 BMI. I have been from 31-35 for the last 2 years because I was working with a Specialist (doctor) in weight management. I have been working with him 4 years, but my BMI was 38 when I started with him. I do have degenerative disc disease in back and neck, sleep apnea, arthritis and a few other health issues. The Specialist said I would probably have pre diabetes if I hadn't been seeing him for 4 years. He thinks the SLEEVE is a good next step, but since he isn't the surgeon, I am not sure how to get him more involved. I have filed an appeal, but don't know my backup plan if denied again. Back to waiting and brainstorming.

I was denied by AETNA due to a BMI under 35 during the 2 years prior to now. I wasn't aware you had to maintain 35 for 2 years. I have submitted an appeal but I am not optimistic. If I have to wait, then I will. I really want to go to my surgeon, and don't have the cash to pay the 15K-20K. Geez...what a process!

I am waiting on approval from Aetna. I have been seeing a doctor for wl for years. We turned everything in on 2/22. They asked for additional information on 3/4 (apparently there were some missing records in 2011 and 2012). I was able to get the information the next day. So, now I am waiting again. I am hoping to get an answer early this week. Aetna said my doctor has my surgery scheduled for 3/18- so I should have an answer this week. I'll keep you posted. I used the instant messenger function on the Aetna website and they were most helpful. I don't know if I am bugging them, but, I have had to stay on top of things to keep them moving along.