polly522

And if possible, call and MAKE sure you have everything you need. Once I met with my surgeon, I called Aetna to find out exactly what I needed and what was required. I know it says something about the 3 month, but with my plan, it was six months. And my surgeons office agreed. They had said that their approva rate was much better with the six month diet program than the three. And yes, sign in at every meeting and seminar you attend!

Yes, they probably will not take that from that long ago. I used my PCP with the six month diet. I also was required by Aetna to see a nutrionalist, have a phyc eval and go through several classes with the Surgeons office. I am just glad that it is all done and only have 3 weeks before my surgery.:thumbup:

First, you need to find out if you will be required to do the 3 month diet plan, or six month. I did the six month, and after all was submitted, I was approved in two weeks. Just so you know the tme line...Info Meeting was Jan/08 and restarted 6 month diet plan (Dr's nurse did not record all the previous weigh-ins) Finished June, Submitted in July, Surgery Date in August. So, it is not a real fast thing. Do you have your surgeon yet? And have you talked this over with your PCP? This is all so important. But the most is what Aetna requires for you and your plan.

OMG, I just got a call from my Nurse assigned to my case.....I have been approved. I am so excited!!!! Now I just have to wait for the date.:thumbs_down:

I just did everything they required. I actually gained weight on the "diet" I went up 10 lbs. I would lose, then gain and so on. I have a surgery date of 8/18.

^ I am sorry to here that. My surgeons office requires it, not matter what, so that was already covered. I was just surprised that I did not have to jump through alot of hoops, but what I already did. I was ready for the appeal process. Now I just need my date. I will keep you in my prayers.

Yes my Nurse says that I have 6 months to have it done from today. She said I should get my approval letter on Monday of next week.

I know, I was on pins and needles, and reading through this website, everyday. They submitted on the 6/25...and I was approved today. So about two weeks. My Nurse was really nice, and this was the first time I actually got to speak with her. I had been calling since Monday. Now I just have to wait for my date, which is probably going to be the first week of August.

I just got approved today too....:thumbs_down:

I feel the same! They will do EVERYTHING for diabetes, and pay, but when you really need the help, that might cure or resolve the issue, it becomes your fault you are this way. Even though millions of studies show that it can be hereditary...I was ADOPTED, so how in the world was I supposed to know!!!!!!

Gosh, I just do not know what to do.....I found out who my nurse was, and have called her like six times. She has not bothered to call me back. I wanted to make sure they have all the info....the staff there are all really nice, and the one today gave me alot of info (like it was pending, and estimated surgery date). But this is getting really frustrating. I just do not know what else to do...........:smile: My paperwork was submitted on 6/25, so it has been several weeks. It gets me kinda nervous that she will not call me back.

Yes, they were very willing to give me my nurses name, and her extension. I just wish she would call me back so I can make sure she has all the paperwork. They told me I was pending, for a surgery date of 8/4, but I know that is just what the Dr. Office says.

Mine is through Costco, so I am hopeing that this will be easy. And thanks for all your help! :embaressed_smile:

How do I find out who my nurse reviewer is?????

Okay, mine was just submitted today for review by Aetna, after I HAD to go through a 6 month diet. So whom do I have to bown nose to get this approved the first time?:tt1:

CONGRATS!!!!:rolleyes2: Good news for you! I cannot wait for that day!

I would just reiterate what you have already said.....and quote al those things about the surgeries and stuff. If you go through the boards, or even the internet, type in "appeal letters for weight loss surgery" you can find a wealth of information......:crying:

Jillypie, My nutrtionalist said that if they deny you 2 times, appeal again and it goes to a Bariatric/Lap Band surgeon for a decision. and more than likely you will get approved. I hope this helps, and you are in my prayers!:crying:

They made me write a letter of why I needed the surgery, along with all my weight loss attempts. Basically it was a letter of medical necessity.

I wanted to do the 3 month, but I was told that it would be easier to be approved if I had the six month under my belt. The coordinator in the office said that she rarely saw the 3 month get approved the first time, because Aetna are such sticklers.

I wrote a letter of medical necessity (why I want the surgery), a weight loss attemps letter (with pictures) to the insurance company. This was required by my surgeons office upon my first visit. I am currently going through a 6 month diet plan ( going on month 5 ) woohoo, so I am almost finished with my requirements. Yes this has been a long process, but will be well worth it. I just hope I get approved the first time, and do not have to appeal.

Why are they not paying for your surgery?:confused2:

I have Aetna, and they require the 6 month diet plan. My PCP is not strict, and I just have to "tell" him what I am doing. I writes it down, we discuss exercise an nutrition, and 'how" to maybe "lose" some weight. He gave me the choice. I am doing South Beach, which I did the first time. I lost 30 lbs, during that 6 month period, but put it all back on the minute I hit phase 2. I have since put back on a total of 40 lbs. So my "records" show that I can do it, but need the help. And with many co-morbs, this will help greatly.

:thumbup: Hurray! Yes I had to do the six month diet thing all over again. The nurse never wrote two of my weights in, so here I go again. But now my insurance only requires a 2 yr, and I have that! So check with your insurance company to see what is required. I hope I get approved right away. If not I will appeal also. I am soooooo thankful for these boards, they have provided me a wealth of information.

Yes, I have decided not to tell anyone. I am a stay at home mom for the last seven years. I usually make my appts when my DH has the day off, so that I do not have to inconvience anyone. My sister knows, but she lives in LA. Her daughter is considering this also. She is 6'2, 20 yrs, and 100 lbs overweight. I told her to go get a full blood workup for everything, because if she is like us, she has all the same co-morbitities as we do.