beTHEchange

Surgery March 17, 2010 I eat the same; but I've modified it, because some foods I cant tolerate. I don't work out as much as I should. I've lost 64 lbs.

I GOT MY APPROVAL FROM AETNA TWO DAYS AGO!! I actually called Aetna with a reference number my doctor's surgery cordinator gave me and they said it was still in pending status but it said "approval all". I was like yessss. Haha, I called back the next day, and it was completed--The information was sent from my doctor on the 18, and on Monday, it was approved. I did the 3 month diet. I'm 23, a mother of a one year old little boy. I've been overweight most of my life. Right now I'm at 324, and I'm 6'1. My BMI is 43. When I did the two year of weight history, I only submitted 3 sets of weights; I don't know what problems people had with Aetna approvals, but I was approved right away. Good luck to everyone. If anyone has any questions about my process and they have Aetna feel free to ask me. By the way, this is my first post, consider this a introduction too. haha!

Congrats! Aetna approved me too. I have surgery on 3/17. I was approved in 2 days. It was really quick. I'm starting the 3 day preop today. I cheated ALREADY. I had a waffle for breakfast, but from here on out today; it will be the strict, oatmeal, grits, soup, water thing all the way up until surgery. Can't wait!! Keep us posted.

Okay guys, an UPDATE! So, I talked to the office mgr and she told me to "disregard" that letter about the On-q pain infusion pumps and that had nothing to do with my surgery. I had to go through the run around with this doctor's office, because the clinical coordinator was still "sick" and they "didn't know when she would return" well I'm sorry honey, but I know SOMEBODY in that office, knows her job and can handle it. It's funny how when you give a little attitude and ask for higher authority people tend to act differently. So finally my surgery is scheduled for March 17th at 730AM! Tomorrow, I go for my preop tests, and then I go on the 16th to pay, which is a total of $60. 35 for the speciality copay, and 25 for some book they want me to have. But before all of this, the clinical coordinator called today, after she checked my insurance benefits and told me that I would pay 35, and then 25 for a book, and then 250 for the "Assisted Surgeon" "INCASE MY INSURANCE DIDN'T COVER IT". I'm what? Me and my mom, and sister's just thought this was unethical and absurb. I have NEVER had to pay for this doctor that was out of network "incase aetna didn't cover it". I abruptly called Aetna, and the representative, said No, I am only liable for my specialty copay of 35. That if the participating facility and doctor, were using a surgeon who was not in network, for them to call provider services to establish an authorization for them to be paid. I called the clinical coordinator back and told her exactly what I had been told. She actually seem to catch an attitude, and say "well when you get that 8000 bill you need to call that representative back, this is because 9 out of 10 times the insurance doesnt pay the out of network doctor" Bull****. I've used out of network doctors before and Aetna has always covered it. Anywho, she proceeded to say, well we will tell the doctor that you do not want to pay the 250 and see if he will still go on with your surgery or not. I said fine. She called back approximately 45 minutes later to tell me, "me , the office mgr, and the doctor have decided to go ahead and waive the 250 fee for you this time". And in my head I'm like I'm sure you will. Yall are not about to turn down all this money for 250, because it would have been just as easy to find another doctor with an assisted surgeon ALL IN NETWORK! UGH, so stressful, but finally all is good. Surgery is set, I know exactly how much I'm out, so 13 days and counting.

Thanks, I'm just so anxious and nervous at the same time. I've been praying since I've gotten the letter. I've done everything right and to the T, so I would hate to not get the surgery due to the disagreement in anesthesia. BUT, the Dr's I go to, don't handle appeals, that I have to go through the "process of appeals" so I don't know what to do. I'm a mess. I guess I will start with Aetna, document what they say, then call the doctor. SOMEBODY TELL ME TO BE CALM. ahah.

What do you think that letter means though? In your honest opinion.

Okay, so I just got my letter yesterday; and I'm terribly disappointed. Apparently, I got DENIED! My sisters and mom, say it's not a denial letter on the SURGERY, but on the type of anesthesia the doctor wants to use. I will type in quote exactly what the letter says, and can you guys please give me some advice on what I need to say to the insurance company. Three representatives have told me I was approved, but now I get this letter...here is what it says... Coverage Decision For: 3/10/2010-3/10/2010 UNLISTED PROCEDURE ABDOMEN PERITONEUM AND OMENTUM 1 Time (s) Coverage for this service has been denied for the following reason: After review of the information received, the specific circumstances of this member and Aetna's Clinical Policy Bulletin: Anesthetic Infusion Pumps, coverage for on-Q pain pump and maracaine block is denied because Aetna considers infusion pumps for intralesional administration of narcotic analgesics and anesthetics experiemental and investigational because of the effectiveness of these pumps has not been demonstrated in well-designed clinical studies in the peer-reviewed published medical literature. Therefore, this, service is considered experiemental or investigational and not covered under the terms of the plan. Then it says the EXACT same paragraph under this Coverage decision for: 3/10/2010-3/10/2010 INJ ANES AGENT OTHER PERIPHERAL NERV OR BRANCH (CONSIDER AS TOS 04) 1 Time (s).. please help me, im so discourage. well guys im headed to church to pray about this now. if anyone has any advice, or any knowledge of this please help me out.

Thanks, I actually haven't scheduled surgery yet. I am still waiting on the official approval letter in the mail; the representative at Aetna, said it would take up to 5 -7 business days, so I'm still waiting. I'm in nursing school in Wichita Falls, so I'm trying to have it scheduled Spring Break which is the week of the 15th in March! I'm too excited. Dr. Hamn, in Plano is going to do it.