SpecialK

Oh my gosh!!!! I just got the call from my surgeon's office that she gave them the info needed on 5 year weight history and Aetna turned around and immediately approved my surgery this morning! I have to now wait to get a surgery date. She says she gives the approved patients list to the surgeons' to schedule and then I should here something soon! :tt2::wub:

Oh my gosh!!!! I just got the call from Charlene at my surgeon's office that she gave them the info needed and Aetna turned around and immediately approved my surgery this morning! I have to now wait to get a surgery date. She says she gives the approved patients list to the surgeons' to schedule and then I should here something soon! :tt2::wub:

Oh my gosh!!!! I just got the call from Charlene at my surgeon's office that she gave them the info needed and Aetna turned around and immediately approved my surgery this morning! I have to now wait to get a surgery date. She says she gives the approved patients list to the surgeons' to schedule and then I should here something soon! :tt2::wub:

Lady QT --thanks for that Monday morning pick me up to get in the right attitude--- offering to help her rather than criticize. I'm just going to pray that today is the day she gets to my paperwork and be content with God's will on how long this takes.

Call Me Joy -- Aetna just reduced theirs on February 8th from 5 years down to 2 years of weight history if there is any chance you have that one. If not, I was told I could get records from my OB/GYN's office with my weight on it if you're a person who goes for annual exam and Pap every year. Just an idea. Oh, and I paid $50 to have my old records pulled from storage but they had them and sent them to the surgeon's office.

Changed my avatar to a siamese cat logo because I have one named Pearl - not purebred but she's a sweetie - and she has a big sister named Patches too.

I was able to attach a picture but it came in HUGE. How do I make it smaller.

LOL!! My nephew was the Expert at Pokemon - addicted to collecting the cards, he organized them into a binder, could tell you which one had which magical power, which enemies, etc. I would just listen to him and say, "that's nice" and just feel so stupid! Anyway, I'm reaching the stage now where I'm a Great Aunt -- two of my nieces have now had babies of their own and its so fun seeing the baby stages again for things. The rest of them are either in high school, the military or college at this point so all Aunt Kathy can do is buy them gift cards! because I'm clueless what they really want or like at this stage. I used to be the one out there trying to snag the hottest toy for them at Christmas..Cabbage patch dolls, Power Rangers, etc. LOL!!!! Nurse Niki- don't worry about the balloon - I was just trying to figure out a way to give it away so we went with what we knew that day on who was going to be the next bandster! I'm hoping I'll line right up with you and Hippiegirl for early March to get banded too.

Suecasb-- that's wonderful news. I'm hoping I get my approval next week. Who is doing your lapband surgery? Do you have a surgery date yet?

I'm going to vent just a wee bit..... The surgeon's office coordinator who does the submission to Aetna called and said I still don't have a 5 year weight history so you need to get it.! I told her the PCP office said they sent it and was willing to talk with her to show her where to look. She said you get them to fax me what I need. I faxed my PCP office and in less than 30 minutes they called me back and said, yes, they copied 6 pages, 1 page per year showing my weights in 2002-2007 and she faxed it to the surgeon's insurance submission coordinator by 4pm today. So then I called back to the coordinator, and left a VM to look for the fax and confirm with me as soon as she had sent it to Aetna. I'm getting a little feisty now but I think I deserve to be given that I've been cooperative and patient for too long now to have office staff pointing back and forth at each other. Okay, I'm done venting. Keep your fingers crossed something happens next week! I'm bummed I lost a whole week this week.

I did get a written letter that Aetna processed the request for surgery on February 6 after receiving it January 31 so that is pretty good on their part. I just need the surgeon's office to confirm they have sent the 5 year weight history. Waiting on a call. I'm trying to stay occupied with other things to keep my mind off it.

Sorry one more thing-- the mother from the orange team -- I suspected they might turn on her because it was actually her that went on the offensive to see if she could line somebody else up to be voted off and I don't think the guys liked it. Then, it was HER that brought up will you promise on your spouse or your children's lives that you won't turn on me?" Well, that is a question she shouldn't have asked because she pinned them against the wall and they retaliated. It was good to see them apologize to the son on last night's show that they needed to have been honest and shouldn't have agreed to his Mom's statement.

I agree this season isn't nearly as good as others. They started out calling it the 'Couples' version and then voted off a few pairs, then suddenly switched to saying it wasn't about pairs of teams any more and then it was back to a Black vs. Blue teams where who you originally came with didn't matter. Its a weird version of things. Second, last night's episode where Jillian brought her mother, a professional psychologist, onto the show was very inappropriate in how they handled this --- they showed the psychologist actually talking with these people about very private things that should only be behind closed doors of a counseling session and definitely not done in front of a camera-- very bad judgement if you ask me for the psychologist to agree to participate, for the participants to agree to it, etc. It was interesting that Bob's whole team said No Way, not sitting in front of a shrink that is the mother of the other team's trainer and coach - too easy to give them a mental edge in the game. Last, it was amazing that the Black team won the weigh off by 1 lb!

Aetna Revises Policy downward from 5 years to 2 Years! Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications. The whole policy is on their website with details for other weight loss surgery requirements for RNY, etc. but this is all the stuff that compares what was in effect Feb 1 to what is in effect now! Hope this helps someone. :mad: AETNA Obesity Surgery CPB Feb 8 2008 Revised.doc

I posted the attachment for the difference on a thread under Insurance I titled: Aetna Revises Policy downward from 5 years to 2 Years! Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications.

Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications. I'm going to post this in the Insurance Thread also.:mad: AETNA Obesity Surgery CPB Feb 8 2008 Revised.doc

Thanks Niki but no, no news today. I wondered if she didn't make it in the office but I did call her and leave another message today. I also found out that Aetna revised their Clinical Policy Bulletin on Friday Feb 8th and I faxed that to her today. It looks like they lowered the years from 5 to 2 years of weight history if I read it right.

I'm going to go check for that Clinical Policy Bulletin and fax to my surgeon's office this afternoon! Thanks so much for the heads up. We've got bad weather in Ohio today and alot of kids are off school so no word from the doctors' office - they could have closed due to snow and ice...wouldn't you know when I'm waiting on the edge of my seat!!

Same boat here! Aetna telling my surgeon's office bariatric coordinator they still needed 5 year weight history and I knew it was something the surgeon's office should have because I had to pay $50 to get the 5 years of records pulled from storage. She called me back and said, nope, no weight history for 2002,2003,2004. Turned back and called the PCP office and they immediately began reading off the dates of my appointments and weights in those years. So now I'm waiting for the surgeon's office and PCP to synch up so the surgeon can submit it to Aetna. Sure is a long and winding road but I feel I'm getting close.

Hi Marie - I had seen a post of yours on the OH website forum and its nice to see you post here. Gosh I am so sorry to hear about what happened with your gallbladder - I had a very acute episode in August 2007 and was leaving to go to Alaska for 2 weeks of all things about Sept 3 so I was worried if I'd make it through my vacation okay but I did. They immediately scheduled me for laprascopic gallbladder surgery, outpatient, at Mt. Carmel East when I got home and it was a breeze for me. Surgery on a Wednesday and back to work on a Monday, so I feel so, so bad for your experience. I wish you all the success in the world for a healthy recovery from your band surgery. I'm waiting on Aetna to approve and according to Charlene, she will get them the 5 year history info (hopefully today) and then it should be approved. I hope to get banded by early March maybe. Several of us have said they need to get a second person to help process paperwork and consult with patients in the approval process but I think I'm so close now, I just need to get across the finish line!

Called Charlene at the surgeon's office this a.m. and Aetna has asked for my 5 year weight history and I told her she already has it. She started looking through the big stack of paper medical records from my PCP and said she couldn't find anything for 2002,2003, 2004 so I immediately called my PCP office and thankfully they hadn't sent the box of records back to storage yet and she was able to tell me that the weight of multiple visits in 2002, 2003, and 2004 was on what was sent to the surgeon's office. I called Charlene back to give her the exact dates on the doctors progress notes to look through and she should be calling me back this a.m. to confirm she's got it. Then I hope she faxes it to Aetna today!!! She said that was all Aetna was asking for. Its getting so close I can feel it!

Second, it was all "good" until the very last paragraph which states: "Client would be a better candidate for bariatric surgery if she took time to prepare for sugery by addressing psychological issues. Major areas of concern to be addressed would be potential for symptom substitution once food is no longer an option and eating behavior that causes reflux. I recommend that client seek psychotherapy prior to and after surgery to address these concerns." I actually don't think this sounds all that bad and I'd let it go. If you are obese, severely obese, or even morbidly obese, there is no doubt all of us have issues with using food as a substitute for dealing with other things in our lives. Yes, we will have to learn how to manage eating for eating sake and not abuse food. I would recommend, and I plan to continue, to see a psychologist/counselor to continue to talk through the feelings I know I will have with dealing with having to limit my food intake and not eating to celebrate, eating when sad, etc. What the letter doesn't say, which is very good, is "I do not recomend this patient have bariatric surgery." they could have been that straight about it and since they didn't I'd just get busy going to a few appointments with a counselor like the others have suggested to document that you are getting prepared in advance of surgery, and that you are willing to work on what they said to do.

Here Here! What a nice bunch of ladies and gentleman! Thanks for taking time out of your busy schedules to share your experiences.

Yes, as far as I know those from Allergan - the AP/VG bands, and the Realize band from Johnson & Johnson now (formerly swedish adjustable gastric band) are the only 2 I have found that are FDA approved for use in US hospitals.

No news on my insurance approval yet :-( Jury duty is over and boy am I glad. I can now let you know I was on a civil murder trial and for 4 straight days I heard more ugly stuff than I ever wanted to hear. We deliberated for 7 hours and I was exhausted when I got home. I was the jury foreman to keep them all working to a conclusion and to communicate with the judge. It is an interesting experience and my boss very kindly let me work from home a half day on Friday as I really didn't feel good because I couldn't sleep Thursday night with all that stuff in my head. To be honest, I think it takes awhile for this stuff to settle out of your head. Anyway, I believe the jury system works and if you get a chance to serve, I hope you will.