The Wait Will Drive Me Nutso!

[buplee 556]

The insurance specialist at my surgeon's office will be resubmitting my paperwork to Aetna. I was denied last week on silly technicalities which could have been easily handled. My original surgery date was 9/27, but now. I am hoping for an October or early November surgery date. I was going to appeal but that takes 45-60 days, so I decided to jump through some more hoops to try to get approved.

Good luck to you all.

[buplee 556]

I was approved last week' date=' after a near fail. Because I have a less than 40 Bmi, I And a comorbidity, they scutinize the paperwork more. I called to check and the insurance person ( not a nurse) insisted my file was incomplete and said I need 2 co morbidities ( not on the plan brochure) 2 years weight history( questionable since my co morbidity trumps that)which would have been difficult since i am not the most compliant and go to the doctor"officially" very infrequently, luckily my Pcp did state my obesity has been decades long in his letter of medical necessity,and some other things that had already been submitted. I insisted on talking to a nurse that actually approves these things. She agreed I had met all the requirements and approved on the spot. Picked my heart up and put it back in my chest.

How did you get to a nurse to speak to you? I was told they do not speak to members. I have a bmi of 49, but no other comorbities. I was told that they wanted a 4 year weight history ( not thevrequired two years), and needed another three months of nutritional counseling. I completed the required three, but did not go back for additional apps since I was getting my other clearances out of the way. It took me three months to complete. I was told I was out of compliance by not continuing with my visits to the nutritionist. The insurance specialist at the surgeon's office was livid and had a very heated discussion with the rep at Aetna, when they denied me. After she challenged them, she was told that my surgery date was two days past the 6 month timeframe to have surgery, and I would have to do three more consecutive nutriitional counseling visit. I am on two of three with the last being in early October.

Maybe they spoke to you as a professional courtesy since you are a RN.

[NDN_RN 527]

How did you get to a nurse to speak to you? I was told they do not speak to members. I have a bmi of 49' date=' but no other comorbities. I was told that they wanted a 4 year weight history ( not thevrequired two years), and needed another three months of nutritional counseling. I completed the required three, but did not go back for additional apps since I was getting my other clearances out of the way. It took me three months to complete. I was told I was out of compliance by not continuing with my visits to the nutritionist. The insurance specialist at the surgeon's office was livid and had a very heated discussion with the rep at Aetna, when they denied me. After she challenged them, she was told that my surgery date was two days past the 6 month timeframe to have surgery, and I would have to do three more consecutive nutriitional counseling visit. I am on two of three with the last being in early October.

Maybe they spoke to you as a professional courtesy since you are a RN.[/quote']

I don't know, but I got very upset with the person I was talking to because what she was saying was ridiculous. I Insisted to speak to a nurse NOW. Now that is Federal BCBs and I must say, they are a very good company to deal with. The original nurse who reviewed my file and the person who answered my call were out of the ordinary.

[Raven21 121]

Buplee, what were the minor technicalities with Aetna that got you denied?

[buplee 556]

Buplee' date=' what were the minor technicalities with Aetna that got you denied?[/quote']

I was told I was out of compliance.

1- I went to my required three nutritional counseling session, and then made appts for my other clearances. That took a total of three months, during which time I did notbgo to the nutritionist and was told I was out of compliance.

2- Due to the above, Aetna requested 4 years of weight history instead of 2 years. The insurance specialist at the surgeon's office submitted the two years normally requested by Aetna.

3- My surgery was scheduled for 9/27 and my last trip to the nutritionist was on 3/25. That meant I was considered too late by two days for the 6 month time limit Aetna requires to schedule surgery. I have now been required to submit to another 3 months of nutritional counseling, fortunately I have completed 2 and will do my last one in early October.

My paperwork will hopefully be resubmitted for approval, and if lucky approved. I hope to have surgery in late October or early November .

These may not be minor to some, but they seemed minor to me.

[Raven21 121]

What a bunch of crap. Seriously.

Thoughts and prayers coming your way for a speedy approval!

[GeauxForIt 659]

So sorry that happened to you!! I fully believe that if we were able to follow the chain of command in an insurance company as far as it could go, there would sit Satan himself at the top! LOL

[GeauxForIt 659]

Ok I have a confession to make...I've checked with Aetna every.single.day sincey paperwork was submitted. Yep, NUTSO!!

[shellbell125 41]

Arghhhh! I can't even submit to Aetna until November 17th! It's already killing me!

I know, they won't be able to submit mine until the end of October early Nov. I know that it's not that far away, on the other hand, it feels like AGES away. Why do we do this to ourselves. I think about it at least every 5 minutes or so.

[ready4change77 88]

Ok I have a confession to make...I've checked with Aetna every.single.day sincey paperwork was submitted. Yep' date=' NUTSO!![/quote']

I have AETNA as well & trust me you will get approved I'm sure... I have a co-worker who we have done this whole process during the same time & our paperwork was submitted around the same time-mine was submitted on a Wed & by Thursday evening it was approved but my coworker it took a week or so to get approval so don't worry it will happen - not sure why it takes some longer then others so I'm sure you'll hear something very soon... Good luck - I was sleeved on 9/12 just last Wed..

Good luck & keep us posted..

Sent from my iPhone using VST

[buplee 556]

Arghhhh! I can't even submit to Aetna until November 17th! It's already killing me!

Raven21,

Why do you have to wait until November? Are you waiting for clearances?

[GeauxForIt 659]

Well...still pending.

I have to admit I'm getting angry now instead of just impatient. And I'm feeling so jealous of all of the "I'm approved" posts. {SIGH}

[GeauxForIt 659]

How can it be that some people get approved on a day or two and I've been waiting 2 weeks?!

[Raven21 121]

Buplee, I have to complete a 90 day program before I can even submit for approval.

[change4life2012 50]

How can it be that some people get approved on a day or two and I've been waiting 2 weeks?!

It is frustrating! I was calling my insurance company 2 times per day on the second week of waiting. I was able to get the process expedited since my doctor submitted surgery dates two weeks out from the date it was submitted to insurance. The rep finally understood that I needed to be able to plan in advance instead of last minute and had it expedited for me. I had my answer the next day. Only downside (if you can call it one) is that it was too late to get the other surgery date. So I have to wait three weeks but that is ok. Finally I was told I was approved.