Crushed!

[Irishflower79 183]

So I will tell you all the reasons I should have the band-

BMI of 55

Heart attack at age 32 I am 34 now

High BP

Depression

Pseudotumor Cerebri with severe papillo edema

Hx of Pulmonary embolisms

Pre Diabetic

Reason Aetna denied me today-

I gained 1.8 pounds since May!- they said they would have denied me with even an ounce gain. They implemented this new rule this month. I have been jumping through the Ins hoops for four months now.

I was suppose to get banded Sept 27 instead I have two more weigh ins

I am crushed.

[kphoping 47]

After the two weigh ins will Aetna then approve you?

[kphoping 47]

I am also sorry for what you are going through too. :-(

[DELETE THIS ACCOUNT! 12,703]

Oh that is complete crap!! I can't believe they'd deny you for such a small gain. I mean, you're trying to get bariatric surgery for a reason. Obviously weight is an issue, what do they expect?!

Stick with it. I know it'll be hard but you can do it.

[NaNa 878]

Wow that is ridiculous! Atena is on of those insurance companies I've always hated! I've always had to appeal just about anything I had with them, thank god most of my latest jobs have Blue Cross/Carefirst.

I would not worry too much, they are just making it difficult hoping you will give up, or yet keep gaining. Keep your eye on the prize, and stay focused, you can do it.

[AZ Gary 149]

Tell then you want a second opinion from someone that is medically qualified, not from someone on the approvals team. It is well documented that the average person can fluctuate as much as 5 pounds in a given day. For females that can be even greater depending on time of the month. In Arizona you could have weighed the first time during one of our high heat days in the afternoon and the second time during a cooler period when you may have been better hydrated. That is also not counting the type of clothes you were wearing. I would point out that the percentage difference of your total body weight. Also ask them if they would prefer to handle this in front of the state insurance board which is going to be more costly for them.

[Bandista 7,466]

We live in crazy times for healthcare, that's for sure. Is it possible the doctor/hospital can appeal this absurd decision -- can you go at it from both angles (you, the insured, and them, the provider)? So sorry you are going through this. It's very frustrating, but you can do this. You are almost there! A few more hoops, don't let the Bastards get you down!

[GoingforGoal 1,734]

OH Jesus Mary Louya. OK so this is how you beat this crap..you take a diuretic and laxative a couple hours before you weigh in. Don't eat or drink before weigh in. You insist on weighing in NAKED. That's right Aetna, let us resort to unhealthy loopholes so we can fake losing weight to satisfy your stringent requirements that completely conflict with the patient's disease.

Insurance companies don't understand medicine, they understand numbers. And in this case, the numbers satisfy their completely irrational decision.

Keep pushing hon... (and please disregard my advice, it was a joke)

[Irishflower79 183]

Tell then you want a second opinion from someone that is medically qualified' date=' not from someone on the approvals team. It is well documented that the average person can fluctuate as much as 5 pounds in a given day. For females that can be even greater depending on time of the month. In Arizona you could have weighed the first time during one of our high heat days in the afternoon and the second time during a cooler period when you may have been better hydrated. That is also not counting the type of clothes you were wearing. I would point out that the percentage difference of your total body weight. Also ask them if they would prefer to handle this in front of the state insurance board which is going to be more costly for them.[/quote']

They tried that! Used every "excuse" possible from the clothes I was wearing to that time of the month and that's when the ins came back with even an ounce gain and she would have been denied! They are all very logical reasons for a 1.8lbs weight gain in four months! Lol

I have to do two more weigh ins instead of four and am tentatively scheduled for Nov 14 if all goes well and Ins doesn't come up with more ridicules rules!

Thank you everyone for your kind words and support!

[Daliaha 78]

Im so sorry. That truly sucks. 1.8 lbs.. heck wearing tennis shoes vs flip flops would do that.

I would hope they appeal again.. Speak to a real person..

[PuraVida37 715]

Irish, I was so looking forward to being a Sept buddy with you. I'm sorry they denied you. That is really stupid. Can't your surgeon's office appeal for you?

[Sojourner 2,446]

So I will tell you all the reasons I should have the band-

BMI of 55

Heart attack at age 32 I am 34 now

High BP

Pseudotumor Cerebri with severe papillo edema

Hx of Pulmonary embolisms

Pre Diabetic

Reason Aetna denied me today-

I gained 1.8 pounds since May!- they said they would have denied me with even an ounce gain. They implemented this new rule this month. I have been jumping through the Ins hoops for four months now.

I was suppose to get banded Sept 27 instead I have two more weigh ins

I am crushed.

I'm sorry that you have had to go through this with Aetna. I have had Aetna for many years, and found them to be reasonable to deal with through the years.

Things I would consider doing are to have your physician of record resubmit their letter of medical necessity, along with starting the appeal process through Aetna. Aetna places much emphasis on the causal relationship of your comorbidities to your weight, and therefore the benefits of approving your band surgery.

Aetna personnel should be able to recognize all of this, but in this new age of supposed improvements in healthcare, they, along with hospitals and medical practices are looking to save money in until now in previously unheard of ways as they prepare to go into the new age of quantum leaps backward for quality health care.

Definitely begin the process to appeal their decision. My PCP needed to keep my "approval window" for my band surgery open for an additional year after I completed the then required 6 months medically supervised diet for additional medical issues I had present. He is well schooled on "how to play hardball with insurance companies"- his words not mine!

I wish you luck and a positive outcome to your appeal...

[Lessofmetocome 3]

What about Water weight? You are a woman don't they think about that?

[Irishflower79 183]

What about Water weight? You are a woman don't they think about that?

The medical director used that as an example the Water weight, time of month, clothes I was wearing, and they said even if it was an ounce gain I would have been denied!

[angelabgray 17]

This makes me so mad!! You hang in there and don't give up!