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?

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.

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.

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.

All has been going okay. I had my last required visit with my PCP last week and he said he would have my paperwork done ASAP. I love my PCP, he is really great, caring, and supportive and a wonderful Dr and person. I was called this morning and told it was ready so I went and got it immediately. As I was leaving I realized he forgot to sign one place. I turned back around and had to wait about 20 mins while they waited for him to sign. Off I went to copy everything so I could have a copy. As I was copying I was also reading the Office Notes and his letters. There were so many typos they are practically useless! My name is incorrect in the text -- not even a name, just some letters. Sentences weren't even readable, just some random words strung together. In a few cases I could tell what they were supposed to say but some were just ??????. And the most important point about my surgical need is that my foot CAN'T heal due to the excess weight, but in the letter it says my foot "can heel". :crying: Wrong homophone and without the 't the meaning is completely changed! Noone bothered to read any of this stuff! If they had it would have been noticed that parts were jibberish! So I made the copies anyway. Went to the WLSC and talked with the insurance person to ask about these typos. Of course she said they have to be fixed but she was also confused about why I was bringing all this in. . . because they already sent in my Paperwork to the insurance for approval. WHAT PAPERWORK????? I was holding the paperwork that they needed to submit! I know for a fact they didn't have any of this because they submitted 2 days BEFORE my last Dr. visit and he had none of this done until Saturday! I told her that this is the paperwork they need and asked if she will submit it. She said they will wait until the insurance says they need it. That will delay things weeks and maybe a month or more. I am so frustrated. I am now waiting for the corrected letters which could be a week or so. Then I will just fax it all to the insurance myself. I was really hoping to have the surgery in August, but I am thinking it will probably be September now.

Great! Mark that visit with your PCP as Day 1 and start counting 90 days. Make sure that you are including exercise in your 90 days and that your PCP is documenting it. That is the only thing I am concerned about with my approval. So far there hasn't really been any specific information from Aetna about what they expect for that part of the 3mo program so it is an unknown. If you see a personal trainer or do anything directly supervised for exercise then get some documentation. Make up a checklist for each date you go and have them sign each date or something like that. I did my own exercise so my PCP just documented that in my notes each time. We will see if that works! I am the first one at my WLS office doing the 3 mo. program, so they have no idea how to do all this and what it requires. The Dr. asked me why I was doing the 3mo instead of the 6 mo. I told him "Why wait 6 mo, if I can do it in 3mo!!" Good luck!!

I chose which plan I wanted to do. And I have been directing it myself! I read the requirements carefully, searched for threads here to help me understand it and then set up all the appointments that I have needed and been keeping track of what I need. I set up 3 months with the Nutritionist. I have had 4 visits with my PCP for weight checks, discussion on my eating and exercise and need for WLS. Go and see your PCP NOW. Get it started. Discuss healthy diet and exercise and need for WLS. Get the head start so you have the documentation. Make sure they weigh you at each visit. Be sure there is about 30 days between each visit, and 90 days from the first visit to the last. Find a Nutritionist and set up 3 monthly appointement. I am now waiting for the approval under the 3 month plan. But I am going to continue with another visit to the Nut and PCP in case I am denied. Then I am just in the 4th month of the 6 mo. plan. Be proactive and take charge of what you need. Good luck!

I have been told that when I get the Insurance Approval I will have to pay a $750 program fee. While it kind of stinks I don't mind paying it. They are taking care of all the paperwork and insurance stuff, I will get several post - op visits with the nutritionist and an exercise therapist, unlimited support groups, several pre and post op classes, a large amount of printed educational materials, a bag full of samples of different Protein drinks and bars, and they also have 24 hour access to the doctors. I am not even approved yet and they have spent as much time as I have needed answering questions, talking to me, helping me with insurance/paperwork questions etc. . . My office is very professional, reputable and the doctors really do seem to care about me as a person, not as an insurance windfall. I am willing to pay out of pocket for that level of comfort and security. No way I would more than $1000 though.

I am about a month away from banding (hopefully!) and realized last night that I am not completely sure I understand how this actually works. Here is what I think I know: Normally food goes through the esophogus and into the stomach, mixes with the gastric juices which break it down and then it empties to the intestines. The part of the stomach that signals the feeling of fullness is at the top of the stomach so usualy we need to fill the entire stomach in order to feel full. So the band is placed near the top of the stomach. It creates a small pouch at the base of the esophogus with a small hole between the pouch and the rest of the stomach. So now when we eat the food goes into the pouch. As it fills the "switch" that signals fullness is "tripped" much earlier so we feel full and satisfied much earlier with much less food. The food then makes it way through the small opening and drops into the stomach and mixes with the gastric juices and is processed normally just as before. Have I got all that right???? So here is what I don't understand: What causes the food to actually move through the opening? Why doesn't it just sit there? Is it like an hourglass where the sand just drops slowly through the opening? When people mention being "stuck" where are they stuck? Is it the at the opening between the esophogus and the pouch? Or the pouch and the band? Same idea with a PB--where does the this get triggered? At the esophogus or when the food gets to the band. I often get shaky and lightheaded and have come very close to passing out at times from not getting enough to eat/not eating meals on time etc... Once I am eating a significant amount less than I do now, how will that affect this physical reaction?

I haven't been around and blogging. I had to step away and just let the 3 months go by without stressing and obsessing. Life got busy with my usual summer activities with the kids home and the time has flown! My 90 days required by the insurance ended Sunday, July 5th. I saw my WLS yesterday and he thinks everything will be smooth sailing, but I am the first patient from their office to try to get approval with Aetna's new 3 mo process. He asked why I was doing the 3mo instead of the usual 6 mo process. My answer? "Why wait 6 when you only need 3?" Get this done as soon as possible so I have 3 more months of my life with this tool. I have to admit, I haven't really lost anything. My PCP was actually worried that if I did I might be denied since I was so close to meeting the 40BMI anyway. Maybe I have the wrong attitude but I have a mindset of "last meal". Last night I enjoyed a great Chicken Fried Steak. Not at all healthy, but so good. But I wouldn't eat that after having the band, whether I could or not. I am drinking soda. I know I won't be able to afterwards so why start now? I have been drinking more Tea and Crystal Lite but I don't see why to stop now. My WLS seems to feel the same way also. No preop diet required, except to concentrate on low fat. I do intend to do that. He said he felt there was no reason to go to protein shakes before the surgery since I will be sick enough of them afterwards! I see my PCP for my final visit next Thursday. Just my luck that he is on vacation this week so I have to wait! As soon as he writes the insurance letters they can be submitted and the approval wait begins. My surgeon can schedule within a week or two. Ideally I want the first Thursday in August--the 6th. That will give me several weeks to heal before I have commitments I need to keep the end of August and beginning of September. I can't decide if I am more excited, nervous or just downright scared!

I haven't been around and blogging. I had to step away and just let the 3 months go by without stressing and obsessing. Life got busy with my usual summer activities with the kids home and the time has flown! My 90 days required by the insurance ended Sunday, July 5th. I saw my WLS yesterday and he thinks everything will be smooth sailing, but I am the first patient from their office to try to get approval with Aetna's new 3 mo process. He asked why I was doing the 3mo instead of the usual 6 mo process. My answer? "Why wait 6 when you only need 3?" Get this done as soon as possible so I have 3 more months of my life with this tool. I have to admit, I haven't really lost anything. My PCP was actually worried that if I did I might be denied since I was so close to meeting the 40BMI anyway. Maybe I have the wrong attitude but I have a mindset of "last meal". Last night I enjoyed a great Chicken Fried Steak. Not at all healthy, but so good. But I wouldn't eat that after having the band, whether I could or not. I am drinking soda. I know I won't be able to afterwards so why start now? I have been drinking more Tea and Crystal Lite but I don't see why to stop now. My WLS seems to feel the same way also. No preop diet required, except to concentrate on low fat. I do intend to do that. He said he felt there was no reason to go to protein shakes before the surgery since I will be sick enough of them afterwards! I see my PCP for my final visit next Thursday. Just my luck that he is on vacation this week so I have to wait! As soon as he writes the insurance letters they can be submitted and the approval wait begins. My surgeon can schedule within a week or two. Ideally I want the first Thursday in August--the 6th. That will give me several weeks to heal before I have commitments I need to keep the end of August and beginning of September. I can't decide if I am more excited, nervous or just downright scared!

Me Too! I have my last PCP visit next week and then just have to get the paperwork to Aetna and wait for approval. I am hoping for an early August date if all goes well. Hey! I am originally from Champaign! Grew up there, went to the U of I, and my parents and other family is still there.

You can print out a card here: Restaurant Card Bariatric Surgery -- several choices and hints to make it look more professional.

I think if you aren't scared then that should scare you! This is a major procedure that will change the rest of your life. Fear is natural and is a good thing. I am still a month or two away and am chomping at the bit to have the insurance approval and my date set. But I also know that in the few days before the surgery I will be terrified and by the day before I will be ready to cancel! The morning of the surgery I will most likely be having a complete nervous breakdown. I have had about 7 surgeries (all those absolutely medically necessary) and it has been that way with every one. Usually as soon as the IV is in they order something to calm me down and the rest of the day is much better! You will be fine. Just remember what your goal is-- a healthier you, for the rest of your life!

Hey! Checking in to see how things are going. Keam--YEA! on having the surgery. So how was it? How are you feeling? I have just sort of been on auto-pilot the last month or so. Busy, busy, busy with the kids end of school and start of swim season. I enjoy staying busy but it keeps from checking in online sometimes. I did make a big OOOPSIE! I had my 3rd appointment with the nutritionist at Dr. T's office on Friday and I completely forgot about! I actually remembered it on Wed and Thurs and made the mental note to not forget it. Then we had a pipe leak in the kitchen Thursday night and we were up late cleaning up. I was so bleary Friday morning I completely forgot my appt. Didn't even remember until Saturday. I will call tomorrow and beg for forgiveness (and pay whatever missed appt fee I have to) and reschedule. My PCP is extremely supportive and I am seeing him monthly as required by my insurance. I am a little bummed because I initially discussed the surgery with him back in April when seeing him for something else. I was hoping he would use that as my first official consult date but he dated the first letter to Dr T/insurance in May when I had a weigh in. It isn't a huge deal, just delays me a month in completing the insurance requirements. I have mostly just been pushing this all out of my mind. I am a do it now kind of person so the waiting would kill me if I didn't put it on the back burner and try to forget it for now.