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Everything posted by dede0314
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Omg that's awesome... Thanks Thanks... Thanks... Yes I've been working on focusing on myself and getting myself together in every aspect of my life
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Check the requirements for Cigna. I have Aetna and in the bulletin it says that you can not have a net gain during the supervised weight loss program. I gained during the 90 days and sure enough I was denied. I was later approved but that's a long story . But it really depends on the requirements of you insurance company. If it doesn't say anything about having a net gain then I think you should be fine.
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Should I tell my pcp about my surgery ?
dede0314 replied to quevedo05's topic in Tell Your Weight Loss Surgery Story
I think you should tell your PCP. Even if you only go to them for your annual physical. I believe its important they know what test should be done when they do your bloodwork. -
hit like a ton of bricks...DENIED!
dede0314 replied to Anxious2beme's topic in PRE-Operation Weight Loss Surgery Q&A
Sorry you're going through this. Don't give up appeal until you can't anymore. My insurance denied me three times and I finally got approved through an external review. It's frustrating because it takes time but it's worth fighting for. -
I finally got APPROVED!
dede0314 replied to _Brooke_'s topic in PRE-Operation Weight Loss Surgery Q&A
Congrats!! -
Congrats! I also have been working through this process for a year. I finally got my approval last week and I am meeting with the surgeon on the 23rd and I should be getting my date then. I wish you the best luck on your journey!!
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Just got my approval and surgery date
dede0314 replied to tinkerrbell1's topic in PRE-Operation Weight Loss Surgery Q&A
Congratulations!! -
They did take a few days to get back to me when I first filled out the form. I also called them and left a voicemail.
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Congrats! I have my pre-op visit with my surgeon on the 23rd and will be getting my surgery date then. I am beyond excited. Good luck with your journey.
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Thanks everyone!
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Aetna...What did you do to get approved?
dede0314 replied to dede0314's topic in Insurance & Financing
I actually just got my approval today... I've been fighting with Aetna since February trying to get approved. I gained 9 pounds during my supervised nut visits so I got denIed. I just won the external review. I think as long as you don't gain weight during the process and do everything they require you should be okay. -
I have Aetna and called today and my level one appeal has been denied. I did the 3 month program and gained 9 pounds during the process and was initially denied because of that. I did and extra 3 months and lost 16 pounds and was down 3 pounds from my initial weight and I called them today and they have decided to uphold their initial denial. I am going to hire Lindstrom to do the second level appeal if I get denied again I will do the external review. If the external review is denied I'm planning on going to Mexico. I'm so upset I just want to cry but I won't give up.
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Congrats.... I'm trying to get everything ready for a second level appeal... Hoping that goes well
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@@momma_missie Thank you!!
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When I spoke to the representative she said the notes said that I gained weight even though I lost all the weight I gained. I still haven't gotten the official denial letter in the mail.
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@@bvenegas Good luck and keep me posted on your progress.
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Dr. Ariel Ortiz at the OCC
dede0314 replied to Kindle's topic in Mexico & Self-Pay Weight Loss Surgery
@@JamieLogical Thank You! -
Dr. Ariel Ortiz at the OCC
dede0314 replied to Kindle's topic in Mexico & Self-Pay Weight Loss Surgery
For those who have had surgery with Doctor Ortiz how do you do your follow ups. I'm in the process of trying to get insurance approval but have been denied I'm doing a second level appeal but if that fails I'm seriously thinking about going to Doctor Ortiz but my main concern is post op care. -
Has anyone gained weight during their program and still got approved by Aetna? I've gained weight and my last weigh in is this Friday I'm nervous I will get denied.
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Anyone gain weight and still got approved (Aetna)
dede0314 replied to dede0314's topic in Insurance & Financing
They just submitted my paperwork I'm so nervous. My doctor noted on my paperwork that I'm on medication that makes me gain weight so hopefully they take that into consideration. How long did you all have to wait for a decision? -
Just received a copy of my medical records and it shows my BMI was below 35 during the 2 year period
dede0314 replied to Ladiec2's topic in Gastric Sleeve Surgery Forums
I don't think you need two years of history anymore. Their requirements were revised on 8/12. Must meet either 1 (adults) or 2 (adolescents): For adults aged 18 years or older, presence of persistent severe obesity, documented in contemporaneous clinical records, defined as any of the following: Body mass index (BMI) (see appendix) exceeding 40; or BMI greater than 35 in conjunction with any of the following severe co-morbidities: Clinically significant obstructive sleep apnea (i.e., person meets the criteria for treatment of obstructive sleep apnea set forth in CPB 0004 - Obstructive Sleep Apnea in Adults); or Coronary heart disease, with objective documentation (by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); or Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or Type 2 diabetes mellitus -
Aetna...What did you do to get approved?
dede0314 replied to dede0314's topic in Insurance & Financing
@@nbw1220 I hope everything works out for you. Keep us updated. -
Aetna...What did you do to get approved?
dede0314 replied to dede0314's topic in Insurance & Financing
Thanks for the info -
Aetna...What did you do to get approved?
dede0314 replied to dede0314's topic in Insurance & Financing
@@jessiquoi Did you get approved already? So all you did was meet with a nutritionist for three months? -
AETNA- MISSING PHYSICIAN MONTHLY VISIT PAPERWORK
dede0314 replied to D.Lo's topic in Insurance & Financing
Congrats on your approval. I am just starting the process with Aetna so all you did was visit the nutritionist for 3 months. DId you do anything with an exercise therapists?