Flowerpurr

Thank you for keeping a list of who is going when. Good luck to everyone that is getting surgery this month! This is our month to become healthy! We deserve it. It coulnd't be a better month. Independence month!

Everyone is right about the no alchol thing. The problem is you won't be eating any carbs to help asorb it so you are leaving your kidneys and liver to do all the work there for hurting them. Besides after surgery you aren't suppose to drink. So if you are considering drinking through your two week diet you should consider not getting the surgery. Look at it this way do I want to drink or do I want to die early? Simple choice really.

Hi Psychmolle, Mine is July 15th as well. I feel like it is going to take forever. But only 26days from today!

Congratulations on your approval. I also did the three month diet and I was approved through Aetna as well. My bid day is July 15th. I can't wait!

Wow congratulations to all. I was just approved by Aetna on Monday of this week. I am going for surgery on the 15th of July. My nerves are up to but I can't wait for it to happen. Now I am just waiting for the approval letter! I hope it comes soon.

Hello Everyone, I was approved by Aetna POSII this morning. I was so excited and full of emotions I cried I was so happy. This has been a long journey for me. I started it on January 8th. Went on the New Direction Diet and I am still going. I didn't want to quit until Aetna approved me on my three month pre-surgical diet. Last week it seemed like Aetna was dragging their feet so this is what I did. I sent them a list of diets I did along with the months and how much weight I lost. I also sent them a copy of my diet underlineing everything they wanted on their three month presurgical diet. I also took their clincal policy underlined their requirements for a three month diet and faxed it all to them. If Aenta is dragging their feet show them their policy. I think they forget sometimes. Well I am so excited I am finally going to be a bandster to! I worked long and hard. I went to weekly weigh-ins along with seeing my PCP monthly. I attened nutrition classes weekly. Spent a ton of money for this diet but in the end my life is priceless. I won't die at the age of 40 like my aunt. I will be around to see my daughter grow up. That's really important since I am a single Mom. So everyone going for the surgery. I know the hoops seem unfair but in the end it is worth it. No matter how hard you have to fight don't give up!!!! I got approved my first go around because I followed everything to a T! That is the key. Don't give up! Good Luck to everyone~~~ :tongue2::wub::smile::crying::scared2::smile:

You need to send them a copy of your diganosis of sleep apena along with an appeal letter and your reference number.

WooHoo!! We have the same surgery date. I am July 15th as well. Keep in touch I will be curious to see how we feel the next day.

Hi I to am getting banded in July. July 15th to be exact. I wanted July 2nd but they coudln't get me in. I am having all the same feeling as you. I am scared, happy, and nervous all at the same time. I want this waiting to be over. You jump through all the insurance hoops, than you wait for approval, than you wait for the surgery! I am tired of all this waiting but I know in the end it will be worth. So just hang in there. We can be nervous together since we are going to be banded around the same time. Keep me posted.

I to have Aenta POS and I did the three month multi-discplinary diet. I did the New Direction diet which had everything included in one. So I was able to get away with three months. I had no problem getting approved once all my paperwork was in. You might want to look up New Direction Diet and see if they have it out by you. It's very expensive but worth the money. It's cheaper than going self pay that's for sure. Good Luck!

Of course it's worth appealing. They are just trying to get out of paying for it. Tell them why your weight went down. Do you have any documentation of taking the pills? Did you see any other Dr.'s that year? Don't give up!!!! That is what they want you to do so they don't have to pay. If you need an appeal letter let me know and I can send you a three page one. My email address is Tazz7722@aol.com. If you would like the copy. Good luck! Don't give up and fight, fight, fight!!!

Congratulations on your approval! I to was approved today. I have also been glued to this site since November! Everyone has been so helpful. I feel so informed and can't wait until my surgery. Now I just have to wait for the letter to get to the Dr.'s office

Hello Everyone, Here is the latest and greatest update with the Aetna drama. I got mad at them yesterday for saying they needed to see other diets I have been on. Well my Dr. sent them a list in her letter to them. I sent them a fax telling them all the diets I have been on and how much weight I lost and so forth and so on. With this fax I also sent them their own clinical policy and told them that I did their three month multi-discplinary diet as described in their clinical policy. I also sent them the New Direction diet that I am on and underlined everything showing them I met with a ditecian, exercise psychologist, behaivor modification specalist, and Dr. weekly along with attending nutrition classes. That is exactly what their policy states and that is what I did. I guess you just have to remind them of their own policy. I am still on the diet though until Aenta approves me. Just in case they come back and say you have to do six months! But I will be done with six months on July 8th so hahahaha to them. Sorry for venting but I am really sick of the games. I also found out from the Psychologist that is at my diet place that people who fight and show Aetna they really want this get approved. He said by me faxing information to them and showing them their policy show's them I am serious. So if you are having issues with them like I am don't give up. Remind them of their own policy and keep calling. Twice a day if you have to. Don't let them brush you off if you really need the surgery! Good Luck to everyone!

Wow that is terrible. Did you see what was submitted into Aetna? Maybe you Dr. missed sending in part of the six month diet. Aenta is into playing games right now. So review what was sent in. Make sure all six months were sent in and documented.

Hi Silvers, Why did they deny you? Did they give you a reason? If your bmi is over 40 you don't need to have any co-morbities. Did you do a three month or a six month diet? Did you submit all that paperwork in as well. I am currently waiting for Aetna to make a decision about my case. They are dragging their feet. I really hate Aetna.

Yes that is the best plan I think. Right now I am trying to tred Water to see if Aetna will approve me on a three month diet instead of a six. So I am trying not to lose another pound so I can stay above 40. See I have nothing wrong with me thank gawd and I would like to keep it that way. I would play games with Aetna just like they play them with us!

Ok here is the low down with Aetna. I have them as well and I to was worried about my bmi going below 40 because I have no co-morbities. If you lose weight on the six month diet and go below 35bmi they will not pay for surgery! Aetna sucks and they are trying to get out of paying for anything they can. So becareful on how much you lose plus you need two co-morbities with your bmi being so low. I hope this helps.

Hello, Here is my input on the whole thing. I did the three month diet and now Aetna is looking for six months? Ok their bulletion says you can do three if you do a multi-discplinary. Which is what I did. I paid $1200.00 to do it but I figured it was worth it. Now Aetna is not playing by their rules and requesting six months of documentation! Give me a break! Part of the problem is the nurse at my Dr.'s office didn't send it in the first time around. She said Aetna doesn't need that! If the nurse tells you they don't need the recoreds that she is an idiot! I probally would have been approved by now if the nurse would of just sent it the correct info like I told her she needed to send in. So instead of being approved right now I am waiting and waiting. It took the nurse two weeks to send in the paperwork that she did now another two weeks have gone by. She said Aetna takes a full thirty days to approve. Yeah that is because the nurse doesn't do her job and slows the whole process up!!!

Ok here is the low down on Aetna. I have them as well and I did the three month diet that they state in their clinical bulletion. That is on Aetna.com and type in obesity surgery. They also require a two year weight history of a bmi over 35 with co-morbities or 40bmi and you don't need any co-corbities. You must have at least three months documented weight loss in the past two years that are back to back. You can't have a month here and a month their. I hope this helps. I am waiting right now to get approved.

I just called Aetna to check on my clain for surgery. They said they called my Dr.'s office yesterday asking for my six month supervised diet. I never did a six month. I only did the three month multi-discplinary surgery one! I paid $1200.00 just to do it. I hate them. I don't know how everyone else has gotten away with only doing three months and they get approved. I don't think this is fair. We all have the same Insurance why do they approve some and not others? Can someone please tell me how they got around the six months? I had my Dr. put down a list of diet's that I did in the past. I never went to my Dr. before to have them supervise my weight loss. I never thought of it. Sorry for venting but I am mad!:cool2::cursing::thumbdown::cursing::sad_smile::cursing::cursing::cursing:

Hi Susan, Thank you for your reply. I haven't quit going to my diet place because I was worried that they might not approve me on the three month. But I can show five+ years of morbid obesity. But my suregons said the less info the better. She didn't send over my diet which is why I think I am having so many problems. Do I call the nurse back and ask her did you fax the diet over or wait? She told me not to call Aetna but I coulnd't help myself I had to find out what was going on.

Aetna didn't deny me as of yet. They said where is my six month diet? I did three months on the pre-surgical and I am still going. Just for this reason that they may not let me do three months. Come to find out the nurse which I told last week to send in my diet didn't. Aetna called her again yesterday and said fax it in which I don't know if she did! I am so fustrated. I just want the surgery.

I thought about doing the same thing until the Nurse told me not to. She said it could delay the process or even worse get me denied. So I am just waiting to here. I called Aetna today and they said it was done with the nurse and is now going to review where they approve or deny. Which really this has been pretty fast. It was only with the nurse a day so I don't know if that is a good thing or a bad one? I am praying for a fast approval. Good Luck to everyone! This journey will be worth it once we are banded!

Well thank you and congratulations on your approval. I called Aetna this morning and they said it moved into the decision area. So hopefully I will know in the next couple of days. My Dr.'s office swears they sent Aetna everything they need. If I get denied because they didn't than I am going to pull all my records and go to another Dr. But I have a feeling I will get approved. I have jumped through every hoop and than some. I have letters of medical necessity from six Dr.'s. How can they argue with that? Plus I did what they said on the three month diet and than some. I check in every week with a diet place. Where I saw a ditecian, exercise psychologist, behaivor modificiation specalist, and a Dr. weekly! Plus I checked in with my PCP every month as well. Sooo I did it all. My bmi is 43 so I qualify since I have no co-morbities. So I am praying that I here it's been approved! Let me know how you feel after your surgery.

Hello Everyone, I need to know if anyone else is having this problem with Aetna. I call the customer service they say my file is assigned to a nurse I call the pre-cert dept and they say it's on hold due to not information. My question is to everyone have you had this happen conflicting stories? Plus the nurse at my Dr.'s office said she doesn't need to submit the three month diet I did with all the notes she said all they need is a summary? Is this true? What did everyone submit? I am so fustrated I could scream. I waited three weeks for the Dr.'s office to submit now you are telling me they didn't get it right? Please someone help! I don't want to get denied because of some stupid nurse.