cunner

I just wanted to update my old thread. I did contact obesitylaw and worked with Kelley. She is awesome by the way. After my first 2 denials Kelley at obesitylaw submitted an appeal which was denied followed by a 2nd level appeal which upheld the denial. Aetna simply would not acknowledge that I had any co-morbid conditions. The last appeal is an independent external review which is done by an agency (bariatric surgeon) with no relationship with the insurance company. I heard back yesterday that the denial was reversed and that Aetna has to cover the surgery. They looked at the evidence and determined that my BMI and the presence of several co-morbid conditions made me a good candidate for lapband surgery. I can't express how happy I am :thumbup: I am on my way to Disneyworld this weekend with my family. Hopefully this will be the last time ever that I have to be concerned with what rides I will fit on. This is a journey that I started last December. My goal is that I will have surgery before the December 14th date one year ago that I first walked into the meeting to start this process. Insurance companies can make it so hard and frustrating but it so important to hang in there and not give in to them.

I wish I could be encouraging but I am in the same situation. I got a denial on my appeal yesterday from Aetna. It seems they now have decided that my hypertension I have been taking medication for for the last 8 years is non existent and my sleep apnea which I have been on CPAP therapy for since March is now just "snoring". The high Cholesterol and GERD which are obesity related conditions in which I am also taking medication for are not even considered. They are friggin criminals !!!! I wish you luck. I hate Atena.

The posts you replied to are almost 7 years old. The policy has since changed. Aetna still has some backwards and ridiculous provisions built in to their qualifications but it is no longer considered experimental.

Congratulations CurvyCat. As breiger said, the 2 year histoy is a breeze... that is if you meet it OK. Although I had history of being above the 35 BMI (with several co morbidities) back as far as 2004 I had fallen slightly below 35 BMI about 18 months ago because I was god forbid, dieting and exercising. Even though I have put all the weight back on plus some once again, Aetna used that to deny me. I am now starting the appeal process. I have searched here and found that some others have been successful in similar circumstances so it does give me some hope. Once again, Congrats on you approval. :-)

Thank you Denise and Sweetsagi. This information is very helpful. I am also a firefighter and there are countless studies and statistics I can site that show heart attacks being the leading cause of firefighter line of duty deaths. These state that obesity, hypertension, high Cholesterol and stress being the leading causes of heart attacks. Thanks to the insurance co I can now add stress to my risk factors ( I won't mention that) :thumbup: If I stay above 35 until 2011 and resubmit I expect the hospital will make me go through most of the testing again as it will be about 1 year later. I am curious if mentioning that fact and pointing out that those are additional costs that were already paid by insurance that would be incurred again is a good idea or if it will piss them off. I don't want to sound like I am threatening them but I don't intend to drop below 35 BMI and reset my 2 years. If I meet the criteria are they not then obligated to pay? I guess that might be a question I can ask at obesitylaw.

Thanks for the replies. I am getting over my self pity. Yesterday was tough and I needed to vent. I am ready to move on and start formulating my appeal. I do have a few questions and seek some advice on a couple of things I would like to say in the appeal but I think maybe I will open a new thread so that people will not have to get through my frustrated ramblings to get to my questions. Thanks again for listening. :-)

So my surgery is scheduled for Wednesday 3/31. As of today I am still waiting on insurance approval. I have been calling everyday for the past week a couple times a day and all I ever get is it is pending and they are working on it. The surgeons office is no help as all insurance approval is done through the admissions dept. All they can say is that they have submitted to insurance and all they can so it wait for a reply. Talk about anxiety and frustration. You would think they would want a patient to relax and cut down on stress before surgery. Well that sure isn't happening... I could sure use a liquid diet..just not the kind the Dr's office has in mind :thumbup: They told me to try back tomorrow 3/30 to see what the status is then. Thanks for letting me vent. Maybe they will have better news later this afternoon.

Thanks for the kind thoughts. It actually did work out OK. I got a call from the Dr's office last night saying that they are going to delay the surgery for a few weeks. The issue is that I had a sleep study done which resulted in a sleep apnea diagnosis. My pulmonary appointment wasn't scheduled until 2/29. Both the pulmonary Dr and the insurance Co felt it was necessary to have me on a CPAP machine for a few week prior to surgery which is why they were delaying the approval. This makes sense, but I just wish they had told me that and not caused me so much stress. I feel much better now about it. Now I will just wait for a new date.

My day is March 31st as well. My insurance approval is still pending which is causing a bit of anxiety. I am just making the necessary phone calls and trying not to let it get to me. Good luck to you both. I wish you well next week and beyond.

I am scheduled to have a Lap-band at Lahey 2 weeks from tomorrow with Dr. Sillin. I don't have a whole lot to add as far as experience goes but there sure have been a lot of appointments over the past 8 weeks. Hopefully I get insurance approval without any hassles. Good Luck with yours. Do you have a date yet?

I got a call from the surgeon's office yesterday giving me a surgery date of 3/31. I was surprised it was so soon but also very happy to get it done. My concern is that my wife's family is coming to stay with us for the Easter Weekend starting on Friday 4/2. Only my wife knows of the surgery and I do not plan to tell anyone else at least at this time. Does anyone know how I should expect to feel 2 days after surgery? I had an umbilical hernia repaired a few years back and a sat on the couch eating percocet for 2-3 days and then I was fine. I'm sort of expecting about the same. It will also be fun explaining why I am skipping Easter dinner on Saturday Evening and Brunch the next day. I also am wondering about communion at Good Friday and Easter Sunday. Everyone will probably look at me like I am possessed if I start burping and spitting up my communion wafer on Easter Sunday. That could be awkward. I am unsure if I should try to reschedule for a week later or so or just go with it and make the best of it. Any advice would sure make me feel better about it. -Dave