Omg! Insurance Good News!!

[Jason Can Do it! 21]

I'm so excited I could cry. After a week of bad insurance news and stress this week, I was just approved by Aetna!

Here's the story and I hope others can benefit from the lessons I learned this week.

I am 37 BMI with Hypertension. 35+ and one comorbidity qualifies me for Aetna under my specific plan. I've been worried about Aetna approving me all along since I'm so borderline but I've gone through the process by the book, checked all my facts and was really hopeful I get approval. On Monday I got an email from Surgeon's office that insurance DENIED me. The reason is still somewhat unclear, but it had something to do with the length of time I've been on HBP medication and some uncertainties about my weight fluctuations the last few years. I was shocked because all this was well documented in what was submitted and neither aetna nor surgeon could give me specifics on why exactly I was denied. VERY frustrating.

The Surgeon's office wanted to cancel my 8/23 surgery date until I went through a 30-60 day appeals process. I was like, "NO WAY"!! I've got this date, have been working on this for 6 months--thinking about it for YEARS--and I've made arrangements to take off the week after to recover, etc. I cannot find another week off for the next 4-5 months so I was pissed off!

I called the Surgeon... of course, Murphy's Law, he is on vaca all week and unable to help. So I enlisted the help of my primary care physician of the last 15 years--who I love and knows my history better than anyone--and he did a "peer to peer" review with an Aetna doctor today and reviewed my case and advocated on my behalf. After a short call and review of all the facts, I WAS APPROVED and I'm able to keep my 8/23 date. I was prepared to self pay anyway but that's not ideal... not only because of the cost involved but because down the road, God forbid something serious happens, insurance wouldn't cover that either. So I wasn't psyched about that hanging over my head.

The most important lesson for me here was don't let others get in your way and be persistent... advocate for yourself and enlist the help of others who care and are prepared to help... like my PCP did for me today.

I'm so looking forward to 8/23 and thank you all for the great posts here. It's been very helpful to follow along the last few months and hear your stories. Will keep you posted!

Jason

[Maddysgram 6,159]

That is fantastic! Congratulations! I too have Aetna and will be submitting all the paper work Aug. 31.

I'll follow your lead if I get denied.

[Jason Can Do it! 21]

Good Luck Maddysgram!

[kvr1977 28]

Jason, my name is Kelly. I have Aetna also. I went through a 4 month nutrition and "weight loss" program as required by Aetna, like you, I did everything by the book and tried very hard to follow all their guidelines. Over that 4 month time period I gained 4 pounds. They denied me because I gained 4 pounds! I felt like they were trying to find any loop hole they could to deny it. I became very discouraged and told the people at True Results that I was throwing in the towel. I was so disappointed and sad. I gave up. I spoke to my husband about it and he reminded me that we pay Aetna almost $500 a month for health insurance and that they did not deny it and close the book on it. They left it open for re-submitting! I feel that I deserve this and that we have more than paid for this with all the money we have paid them over the years. We rarely even use our insurance other than regular health check-ups and other little things. I find your story very inspiring. Good for you for taking the bull by the horns and fighting back. I wish you all the best on your big day . All my best. -Kelly

[SinCityGal 43]

Jason,

So happy for you! Thanks for sharing.....I needed this today!

[Jason Can Do it! 21]

Thanks guys! Good luck to you all too!

[cassiem93 39]

That's wonderful news! Only 6 days away. Congrats

[bigenuff 302]

Congratulations ! See you on the other side !! Good luck !