Denied because of 1.8lbs!

[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.

[Ada81 31]

Ohhh no! I'm so sorry! I would be crushed too. Sending you big hugs, just remember all things happen for a reason and perhaps when you do get banded it will be the right time. I know that's not very comforting right now, but take care, you can do this. Xx

[healthyholly34 0]

Were you in a medically supervised diet program at the time? Just wondering because I have Aetna as well.

[2muchfun 8,927]

Your doctor can appeal to the medical director. Their decision is BS of course.

[skb123 308]

I have a daughter with 5 weight related conditions yet her insurance turned her down not just once but twice, now she had to get an attorney involved. All I can say is sometimes they just don't see the forest for the trees! Good luck to you.

[dylanmiles23 2,198]

I would call your doctor, ASAP! You have too many health issues. Gaining weight, in my eyes, shows you need a tool, The Band.

I wish you luck with trying to get your surgery.

[Irishflower79 183]

Were you in a medically supervised diet program at the time? Just wondering because I have Aetna as well.

I was not I had competed the 4mo required weigh ins all the hoops (blood work, psych eval)

Was just waiting for the ok from the ins. Medical director at True Results did fight for me but the ins said even if I had only gained an ounce they would have denied me my starting weight in May was 357.6 and my ending weight in Aug was 359.4 .

So starting today I am on the pre op diet (2protein shakes and a meal of 4oz Protein, 1c of veg, and 1c of fruit) I have two more weigh ins to lose the 1.8lbs and the weight I gained because I was told I was in the home stretch and didn't need to worry about maintaining anymore! HA!

[Dr. Alias 5]

I was not I had competed the 4mo required weigh ins all the hoops (blood work' date=' psych eval)

Was just waiting for the ok from the ins. Medical director at True Results did fight for me but the ins said even if I had only gained an ounce they would have denied me my starting weight in May was 357.6 and my ending weight in Aug was 359.4 .

So starting today I am on the pre op diet (2protein shakes and a meal of 4oz Protein, 1c of veg, and 1c of fruit) I have two more weigh ins to lose the 1.8lbs and the weight I gained because I was told I was in the home stretch and didn't need to worry about maintaining anymore! HA![/quote']

You can do it, show them! Don't give up. Stay focused on what you need to do and make it happen. I wish you the best, sending plenty of encouragement your way!???‰

[The Icy One 518]

I also have Aetna and I received a phone call from True Results yesterday telling me that they had changed the rules and that rather than a maintain/small gain they want me at least one pound under my start weight at my last check in. That is on the 23rd of September. I have a few pounds to lose, because I was told not to worry about it for the four months I was going through this. I should be able to do it without too much trouble, I've already started. I am just so... Sneaky, sneaky insurance company. Sneaky! Pull this sudden rule change to postpone and cancel surgeries to save money. Sneaky. Well, they are messing with the wrong woman. :ph34r:

[Irishflower79 183]

I also have Aetna and I received a phone call from True Results yesterday telling me that they had changed the rules and that rather than a maintain/small gain they want me at least one pound under my start weight at my last check in. That is on the 23rd of September. I have a few pounds to lose' date=' because I was told not to worry about it for the four months I was going through this. I should be able to do it without too much trouble, I've already started. I am just so... Sneaky, sneaky insurance company. Sneaky! Pull this sudden rule change to postpone and cancel surgeries to save money. Sneaky. Well, they are messing with the wrong woman. :ph34r:[/quote']

My next check in is also on the 23 @ 8am. Then I have another one on Oct 21. Hope for surgery on Nov 14!

I was talking with my aunt today and told her "others that have Aetna got the warning but I'm the one that got screwed! Since the change happened 5 days before my last required weigh in! I am happy for you that your still in your hoops to jump and have time to get under the initial weight glad my misfortune helped someone! Lol

I was also told the same thing "don't worry no required loss/gain required"

I have called and pleaded my case and no one cares at the Ins I was just wasting my breath!

[HotButterFly 981]

Irishflower, I see you kicking some ASS in the near future. It brings me JOY just to imagine the look on the face of the person handling your case when they see you not only losing that 1.8, but more than that. They'll have no choice but to APPROVE YOU!!!!

[intelirish 714]

My next check in is also on the 23 @ 8am. Then I have another one on Oct 21. Hope for surgery on Nov 14!

I was talking with my aunt today and told her "others that have Aetna got the warning but I'm the one that got screwed! Since the change happened 5 days before my last required weigh in! I am happy for you that your still in your hoops to jump and have time to get under the initial weight glad my misfortune helped someone! Lol

I was also told the same thing "don't worry no required loss/gain required"

I have called and pleaded my case and no one cares at the Ins I was just wasting my breath!

Keeping my fingers crossed for you.. Insurance companies SUCK.. mine was totally messing with my head about the insurance coverage.. though i finally talked with someone at TR that could answer my q's and i am once again a balanced nut case I know you will get there to where you need to be with NO issues..

[kespy74 103]

That is ridiculous!! Don't they realize weight can fluctuate day to day by a few pounds, and especially for women!! Stress can also make you gain, and they are giving you a heck of a lot of stress!!! I don't have Aetna but rather Tricare Prime. I really hope they don't make me go through hoops. I haven't gone to my PCP yet and I am scheduled for the seminar on Saturday the 21st of September. I am really hoping to be banded by the end of the year so I can start the year off right.

Good luck to you!!!

[sylvia42 43]

What process did u have to go thru for ur insurance?? I have Aetna also was it hard to get a reponce??

[The Icy One 518]

My next check in is also on the 23 @ 8am. Then I have another one on Oct 21. Hope for surgery on Nov 14!

I was talking with my aunt today and told her "others that have Aetna got the warning but I'm the one that got screwed! Since the change happened 5 days before my last required weigh in! I am happy for you that your still in your hoops to jump and have time to get under the initial weight glad my misfortune helped someone! Lol

I was also told the same thing "don't worry no required loss/gain required"

I have called and pleaded my case and no one cares at the Ins I was just wasting my breath!

You will blow it out of the Water, Aetna will pay and you will win.

It's crazy how one minute, it is all don't worry about it, no loss/gain required, the next, they change it up and if you are just days away from your check in, too bad for you. More time and more hoops to jump through and what do they care? They are heartless, it is all about the bottom line. I think that that part if it is the impending roll out of the ACA has them running scared. It should. Insurance companies have run roughshod over us long enough. It is time for them to learn their place.