GettingDHealthy

Hey all, I was just wondering if there was anyone here who has dealt with Aetna and been approved on an appeal? I just found out this week that Aetna denied my surgery because the plan my company has doesn’t cover bariatric surgery. I am appealing but was wondering if anyone has ever had success with an appeal through Aetna?

I called and spoke with an Aetna representative when I started the process and she told me that I needed to have the surgeon submit all of my paperwork to find out if the surgery would be approved or not. She didn’t say anything about an exclusion. I wouldn’t have gone forward with everything had I known.

I’m on Aetna PPO and got denied this week even though I meet all of the requirements for surgery. They said that bariatric surgery is not covered under this plan 😞

I was originally told that my surgery would be scheduled sometime at the end of June. Talked with the surgeons office this week for a check in and my surgeon has taken the month of June off to travel. I’m excited for him but a little bummed at the same time. This pushes my surgery back to mid/end of July. School starts mid August and I’m worried I won’t have enough healing time before I go back to work....trying not to stress out!

Crossing fingers that I will have a June surgery! Had a check in with the surgeons office yesterday and I have one more PCP appointment before we submit to insurance but they are thinking end of June, early July. 🤞🏼🤞🏼🤞🏼

April marks my 5th month of a 6 month medically monitored weight loss plan that was required by surgery. I’ve done everything else that the surgeon required and now I’m just waiting. I’m starting to get nervous about whether or not my insurance will approve me for the surgery...or that I will have gained weight and not be able to get approved for the surgery. According to my PCP and my surgeon, I meet all of the requirements for the surgery and I’m down 7lbs. from my starting weight but I’m struggling to lose anymore. I can’t seem to help stressing out about it all. What do you do to get out of your own head and not stress? Any words of encouragement are welcome!

How did it go?

Who is your insurance through? Did you have to wait for insurance approval before they set a surgery date?

Dang! I had to have 6 months with my PCP, see a psychologist, a dietician and get chest x-rays/abdominal ultrasounds. The surgeon also requires that you attend 3 support group meetings.

I was given a preop diet that starts 2 weeks before surgery. The dietician I spoke with told me that it’s to help shrink my liver a bit so the surgeon can get around it more easily during the surgery.

I’m with Aetna too and am on month 5 of my 6 month medically supervised weight loss. I’m getting a little anxious to see whether or not they’ll approve me for surgery. 🤞🏼

Deep breaths, you can do this!! My intake was about 4 hours long and there was 4 other people doing it with me. They did bloodwork and urine sample, my biometric screening, a urea breath test, and then we met the surgeon. He explained all of the different procedures to us all in a group and then met with us individually. I am relying heavily on my insurance coming through so we talked about that whole process and what we’d do if I got denied. They will do everything they can to help with whatever insurance needs. They gave me all of the referrals I need for my insurance, as well as detailed information on the procedures I was looking at having done, and then took a “before” picture and sent me on my merry way! This month will be my month 5 of the 6 month observed weight loss time that my insurance requires. Im excited and hopeful, trying to stay positive. I do have the nagging thoughts in the back of my mind of what I’ll do if I’m denied but I try to not think about it. I’ll cross that bridge when I get to it, but for now, I’m pushing forward like insurance said “go!”

I’m in!! Starting weight: 357 Goal: 200 Surgery Type: Roux en Y Am working on Preop, am coming up on month 5 of my 6 month monitoring!!