AETNA- confused

[sueob1968 3]

I have AETNA insurance. After 2 1/2 weeks of waiting on an answer, I was denied. Apparently, I haven't been over 35 BMI long enough. I have only been below, with the help of my PC who specializes in weight management. I have had 1-2 visits with him per month for 4 years. I have been over 30-35 BMI for YEARS (since I was a pre-teen.)My PC office sent 70 pages of documentation. I have his support for the Sleeve. I am devastated that I was denied. So, I did get a call from a patient advocate. What will they do for me? Do I have any chance of getting approved, or do I need to stay at my high weight for 2 years? It just doesn't seem right that I have worked hard, but not had much success, and now my alternative is to be unhappy and unhealthy for 2 more years, so the insurance company will pay for this. Thoughts and ideas welcome

[DrmBig4Evr 152]

I'd talk to the patient advocate at your surgeons office or whomever is handling your approval. You can fight it and might be worth it. I tried to fight it but it didn't work so when I landed a job with better insurance I tried again with the same letter and diagnosis and I was approved. My thought would be to sit down with the insurance coordinator or whomever is working on the approval for you and put together an appeal package. It can't hurt.

[Naija2atl 30]

Why wait 2 years ? 2 years you could be slim and healthy . Consider self pay , Medical Tourism maybe ? I only whish I knew about this years ago , I would have skip some really embarrassing moment (I looked like a beached whale in my honeymoon pics I had to delete most , not walk around with HBP for the last 3 years.

[schavez2010 32]

Is self pay an option for you? I knew my insurance wouldn't pay so I didn't bother. I did self pay $4700. But it is in MX. Everything is great there. The quality of care etc. there is a specific forum for it here. Check it out if you're interested/:)

[sueob1968 3]

Thank you for the suggestion. I am not sure what I will do. How is 'after care' handled if you had in MX?

[nurseghana 167]

I have AETNA insurance. After 2 1/2 weeks of waiting on an answer' date=' I was denied. Apparently, I haven't been over 35 BMI long enough. I have only been below, with the help of my PC who specializes in weight management. I have had 1-2 visits with him per month for 4 years. I have been over 30-35 BMI for YEARS (since I was a pre-teen.)My PC office sent 70 pages of documentation. I have his support for the Sleeve. I am devastated that I was denied. So, I did get a call from a patient advocate. What will they do for me? Do I have any chance of getting approved, or do I need to stay at my high weight for 2 years? It just doesn't seem right that I have worked hard, but not had much success, and now my alternative is to be unhappy and unhealthy for 2 more years, so the insurance company will pay for this. Thoughts and ideas welcome [/quote']

I had my surgery in Mexico I was denied 6x by them good luck