mrobles1027

Im looking in to getting a revision from lap band to sleeve. My paperwork was submitted on 10/24 and found out today that it was partially denied. I was approved to have the lap band removed but denied for the sleeve. My doctor's office will be doing a Peer-to-peer appeal on Tues or Wed. Did anyone have to go through that with Aetna? If so, what was the outcome?

A total weight gain? Like you weighed more at your final weigh in than you did when you started? Or did you gain a pound or so while doing your weigh ins? I started my consulation in May and my first weigh in was at 225. Around the same time I got on birth control. I delayed going to my doctor because I wasnt sure if I was going to do it. When I went back in late July I had gained like 12 lbs. It was so hard to lose it during my pre-diet. My last weigh in was at 242.

I know the feeling. I was recently denied as well. So Im waiting to see my doctor and do an appeal.

I am getting a revision from lap band to sleeve. I got my lap band in 2010. Everything worked fine until I had minor complications almost a year later and after I had my daughter. So it really isnt working for me anymore. I have almost gained all my weight back. I look forward to my journey with my sleeve. However, my doctor's office submitted my paperwork to Aetna on Oct 24 and still havent heard anything. Ive checked with the coordinator and Aetna and they just tell me its pending. Today is the 10th business day from when it was submitted. Aetna said additional information was submitted on 11/2 and told me to check on Monday. Anyone else playing the waiting game? Im ready to get this party started lol

So Aetna didnt overturn it with the peer to peer appeal. I got a quote from Lindstrom Obesity Advocacy but I dont know if I can do $600 to $900 to help with the appeal. So I am unsure whether to just let my doctor handle the appeal or have Lindstrom do it. Im so depressed because I really wanted to get it done this year.

I feel the same way. It was submitted last Friday, even though I know their turnaround is quick. I'm nervous to call because I've been denied in the past also.I got the call today! I'm scheduled for a sleeve gastrectomy on 12/22. Wow! This just got real! Sent from my SAMSUNG-SM-N910A using the BariatricPal App Wow! Congrats!!! How exciting!

I was just denied by Aetna due to weight gain. My doctor did a peer to peer appeal and they didnt overturn it. So Im waiting to see what the doctor says and whats my next step. I started birth control around the same time I went for my initial visit and I think that is the main reason that I had a lot of weight gain.

Hello, Quick question. Did they require that you lose the weight you gained during the preop diet? I was recently denied due to my weight gain.

Wow! That sucks. Hope it's a speedy approval and you get a date this year. I'm going to call my doctor's office today Sent from my iPhone using the BariatricPal App

Same here. I want to get it done before the end of the year because my deductible is paid in full. If I get it done I will need to pay it again. Not only that I really just want to start the process already. I think you'll get good news. Give them a call. Sent from my iPhone using the BariatricPal App

I'm in the same boat. My request for prior authorization was submitted on Oct. 24th and I've been waiting for the call ever since. I'm just trying to have patience and keep telling myself that it will happen as soon as it can and for now it's out of my control. It feels like agony waiting though, or like it might not really happen until I have the official surgery date. Sent from my SAMSUNG-SM-N910A using the BariatricPal App Thats how I feel. Have you called the insurance directly? Do you have Aetna? Im going to call my doctor tomorrow to find out about the appeal.

How long was the whole process from your first visit to your surgery date? Do you have Aetna? Sent from my iPhone using the BariatricPal App

Congrats!!! Good luck and keep us posted. Sent from my iPhone using the BariatricPal App

It was partially denied. The approved the removal of the band but not the sleeve. So Im waiting for my doctor to call in and do a peer to peer appeal. So hopefully I will know by Wednesday. Thank you!

I was given a partial approval to my pre-authorization today. I was approved to remove the band but denied sleeve. Doctor is going to do a peer-to-peer appeal this week so Im hoping to get good news. Ive had so many complications with the band that is just stop working for me.

So Im a little sad that my request was partially approved. Aetna approved the removal of the Lap Band but not the sleeve. Spoke to my doctor's office and they said they will have my doctor to a Peer-to-Peer Appeal. So I wont know until maybe Wed or Thurs what the outcome of that is. I was so excited and looking forward to it to. I didnt really understand the reason for their denial either. They said I was non-compliant with the band because of my weight gain but dont see the issues I had with it. So heres hoping for the best.

I'm in CA. So I wouldn't know. Have you started the process?

That's good to know. My doctors office said that they got a denial for someone who didn't lose weight in the 6 Month diet. Keep me posted!

I called earlier in the week and the rep I spoke to last called me back a bit ago and told me that is still pending. He'll call me on Monday he said. Sent from my iPhone using the BariatricPal App

Oh bummer. Well at least it's still in process. I'm sorry to hear that. You should call Aetna directly on Monday just to make sure they have everything. I've called them twice this week. Yes I hope Aetna delivers good news next week. Please let me know as well when they tell you. My only qualifier is my BMI and having complications with my band. So we'll see.

I'm getting a revision from lap band to sleeve. My paperwork was submitted over a week ago. I checked today but still pending. What is the usually turnaround time with Aetna? I'm scared I'll be denied

Thank you. I called today and they said they received additional information yesterday so its still pending. I'll try tomorrow again.

Hi All, Im new to this forum and site. Im trying to get information on what others went through when they had a revision surgery from Lap-Band to Sleeve. I have an appointment with a doctor this Friday and have called another doctor to schedule a consultation. My main question is whether they made you go through all the requirements again and how long did the process take before you had a surgery date scheduled. In cases where you were denied were you given the reason as to why you were denied. Appreciate the help with this. Thank you.