WDW Luver

I have seen this question asked but not answered so I am hoping by posting fresh I can get answers from those on Aetna that were "on the line" of the 40 BMI. I applied with Aetna and jumped through all the hoops last year only to be denied because my BMI didn't actually hit 40 until just before I started the process. I have none of their listed comorbidities--I have joint and mobility issues do to the weight and that isn't covered. So I will be reapplying when I have 2 years of records with 40 BMI. But is it really only 2 years of proof, or is it technically 24 months? In other words I was weighed at 40 BMI in July of 2009. I am still at 40 BMI (and will make sure I stay there!) and get weighed in every time I see my Dr--we have a wink wink deal that I go in for any ache or sniffle every few months so that I can also have a weight recorded. So I have proof that I was at 40 BMI in 2009 and in 2010 and will apply again in 2011. I would love to actually start my pre op diet the end of this year and reapply in Jan 11 and get the surgery scheduled and done. But the CPB does say: obesity that has persisted for at least the last 2 years (24 months) Does this mean that I really need to wait until July of 2011 so that it will be exactly 24 months from when I can prove my 2009 BMI??? Of course they won't even tell you the answer to this or provide a "partial" approval until you spend the money for the nut. visits and dr. visits. I have already paid all that once and will have to again. I really don't want to have to pay it all a third time if I am denied in Jan 11 and have to wait until July.

Anyone know what exactly this is? This is one of the comordities that my insurance will approve on. I have already been denied and lost my appeals. But quite interestingly my bp has been going up the last few months and is now REALLY high! Kind of scary but I see the dr tomorrow. So I am wondering if this unfortunate twist could end up being the problem I need to reapply and get approved.

So I have been denied by Aetna and exhausted my appeals. My weight wasn't high enough for the last 2 years and I have no comorbidities. So at the very least I figure I can be miserable for 18 more months (I hit 40 BMI 6 months ago) and then reapply. But quite interestingly, my BP has shot way up. Like really bad high. If my Dr. says I now have high BP can I go ahead and reapply?

NOTHING! That is the problem. I have had a BMI over 35 but no comorbidities. Without them I can't qualify. I am going for a sleep apnea test next week.

kmiller, I saw your thread. It sounds like hopefully if you can just the proper documentation from your dr--or from a NEW dr. then you can get approved. I can't believe your dr office is being so stinky. DH has said that if the insurance won't do this then we will self pay but I really don't want to. My insurance covers it, we pay for the insurnace, they should pay. My WLS did tell me that he thought we could appeal since other insurance's cover based on "musculo/skeletal problems" and he would fight my insurance that they need to cover based on that also in my case. My podiatrist is ready and willing to write a letter on my behalf as is my PCP. I am lucky to have a great supportive office staff and doctors.

I am so disappointed. Aetna has denied me. We will appeal but for now I am so upset. I am an optimist, I really didn't think I would be denied. But based on my 2 year history I don't meet Aetna's policy for approval. No co-morbidities. Healthiest fat person I know. Well except for the severe foot and ankle problems that have me disabled and unable to walk. Problems I have been told will be greatly relieved by permanent weight loss. I will get more letters and submit them. My dr's office will help me appeal. I am just so upset right now. I thought I would be approved. Heck, I was hoping I would have had the surgery by now.

Well I finally got a decision and it isn't good. I was denied because of my 2 year history. No co-morbidities with a BMI between 35-40. At least none of their co-morbidities. The fact that I am disabled because of severe foot issues aggravated by the excessive weight means nothing. We will appeal. I will get more letters from my doctors and my podiatrist. Until then I will cry.

Congratulations!! So that is what Aetna has been doing! Approving all of you instead of me! I am jealous! The WLC submitted my paperwork with my weight history for the last few years and a letter from my PCP and their visit information on July 13th. Except that I didn't have my last PCP visit until July 16th! And I didn't have all the office notes from those visits until the next week, around the 20th. So of course Aetna kicked back the first one for more information. Then once they had all the paperwork I thought I would hear. Nope. Called last week and they needed to talk to the WLC office for something but couldn't get through. I called them, they called the insurance company today to give them what they needed-- the insurance liason told me today that they asked for information that was already sent.:smile2: So I am waiting. And waiting. And waiting. I am going to call them again tomorrow. I am calling every 2 days. Maybe if I bug them to death they will push me through!

The 3 month program is new and not many have been approved under it yet. I am the first one at the WLC here that is doing it. I am currently waiting for my approval and it is taking them quite awhile. I am really hopeful that it will come this week. The exercise part of it is the most misunderstood part of the 3 month because no one really knows what the requirement wants--including Aetna!! My dr documented in his records what I did. But I also have a contraindication to exercise and he noted that I was trying but not really able to. If you want to be overly cautious you can hire a personal trainer and then document each visit with them and have them sign something for you. If you go to a gym you can see if you can get a printout of your visits. If you exercise independently--like walking-- then make sure your doctor notes it each visit. Just to be safe, while I am waiting for approval under the 3 month plan I am continuing my visits with my PCP and the nutritionist so if they deny based on the exercise part I can resubmit in 3 more months under the 6 month. Don't wish we could lose weight with all this jumping through hoops?!!

I really like the idea of just being really noncommital when she asks how much you have lost "Gosh, my scale broke and I haven't had time to get a new one." Continue to stick to YOUR new lifestyle and eating habits and don't worry about her. It isn't your place to give her advice. If she asks or finally decides to get back on the "bandwagon" and wants support then maybe you can help her work on some menus together but until she is ready to commit you can't do anything to help her. If the situation with food being offered in the office gets uncomfortable you can always make up excuses like "I had a huge lunch and am really full" or "I am not feeing very well" and of course just try to make yourself scarce when the birthday cake comes out! If someone brings you something you might accept it graciously and then toss it later where they can't see. The social graces with food can be such an issue when losing weight but since this is a boss/employer issue I would tend to make sure that I dont' make a big deal out of my weight loss and just try to get around the issue. Good for you for sticking to it! Hopefully your boss will come back around and see what a difference it is making for you!

Are you standing up, sitting down or lying down? Is there a choice? I am a fainter and am really worried about this!

I was going to suggest that may be lactose intolerant also. You can get Lactaid pills (or the generic equivlant) at any drug store. Try taking one or two with your Protein shake and see if that helps. If you are thirsty make sure you are getting enough Water, particularly if you have diarreah. You need to up the water when that is happening to keep you hydrated. I think it is completely normal to be scared. I have written before that I think if you aren't scared that would be a problem! I am waiting for insurance approval and keep going back and forth between "Hurry up already I want to do this NOW" and " What in the hell am I thinking? Someone is going to cut into me and mess with my insides. Am I in INSANE?" I think being scared shows that you know what you are getting into. You understand what you need to do to make this work. You understand the potential risks. That is a good thing. You are here. You have support here and can come anytime to get words of encouragement and advice. Don't think so much in terms of your outward appearance when you loose weight, but the health benefits. The stress you will take off of your heart, lungs and joints. The years you will add to your life to enjoy your loved ones. The things you will be able to do that you can't enjoy now. The rest will follow. *Hugs* ETA: Also check out this thread on the Cooking forum for some Protein Shake recipes: http://www.lapbandtalk.com/f82/200-protein-shake-recipes-49774/

My 3 month period is over, after some difficulties getting all the paperwork correct from my PCP it has all been sent to the WLSC. They faxed half of it last week and the rest was sent today (long story!). While I am waiting for the approval I am continuing my nutritionist and PCP visits so I will still be on track for the 6 mo program that is normally done in case the 3 mo program is denied. Now I just wait and wait. I was really hoping to have the surgery the first week of August but obviously that won't be able to happen. The insurance said that it could take a month for approval. But I have also read about others being approved within a few days so I am hoping that I will be one of those! I think this will be the hardest part--just waiting for the approval, this is the big unknown.

Deep Breath. I have talked to the Insurance company several times today. They said to just send it in myself and not wait for the Dr. office. I do have copies of the actual office notes for 3 out of the 4 PCP visits and I have called and asked if I can get the 4th one tomorrow. Hopefully I can pick it up in the morning and fax it all to Aetna by noon. I still need the transcribed Office Notes and his letters, but hopefully this will help the process.