bosoxgirl1966 20 Posted October 2, 2013 I have Aetna POS II plan. My BMI is 39.7 and I have high blood pressure and sleep apnea. My info was submitted to Aetna on Wednesday and I called today and it is still pending but they did tell me it was being currently reviewed by the nurse. I wish I thought of submitting a letter with my file. I guess if I need to appeal I can include one Share this post Link to post Share on other sites
Jessica108 10 Posted October 2, 2013 So, Aetna gave the impression I was going to get approved if I had my sleep study done, HOWEVER, since they denied the test, the waiting game goes on. Here's hoping I get some positive news in the next few days. Share this post Link to post Share on other sites
MrsYoungJr 4 Posted October 2, 2013 I have Aetna. I haven't submitted my paperwork yet still waiting on them to decided about this whole sleep apnea mess. I just had my 3rd sleep study. The 1st was a split night. Meaning if my breathing got bad enough then she would wake me up and put me on the machine. Well she didn't wake me up but she said they still may make me come back cause I had some moments but nothing severe. Well my 2nd one they put me on the CPAP the whole night. Results came back and they said I didn't tolerate the CPAP so the wanted me to come back and get on the BYPAS now I'm waiting to see about that. I'm going to the Dr. this morning when my husband gets home. I have to get the rest of my paperwork together so I can get ready to send off for approval. Share this post Link to post Share on other sites
nh20013 15 Posted October 2, 2013 I just literally got back this morning from sleep study #2 ... OMG that Cpap was horrible but I rode it out all night! As soon as I get the results I'm submitting the paper work for my appeal! Hopefully this will do the trick! Share this post Link to post Share on other sites
bosoxgirl1966 20 Posted October 2, 2013 I have severe sleep apnea. I always knew it but never had been diagnosed until I started this whole precertification process. I can finally sleep more than an hour at a time. Its incredible. You get used to the mask. My results showed I stopped breathing 62 times every minute Share this post Link to post Share on other sites
nh20013 15 Posted October 2, 2013 Yeah I had never thought of doing a sleep study let alone think I had apnea but when I got denied at a 41 bmi with high blood pressure I figured I would have the study done much to my surprise I have severe sleep apnea too not sure how many times in one hour I stopped breathing ... Hopefully I will get my approval lose this weight and not have to worry about it. Share this post Link to post Share on other sites
bosoxgirl1966 20 Posted October 2, 2013 If I dont het approved I am going to be devastated..trying to get all this completed before deductible kicks in again Share this post Link to post Share on other sites
nh20013 15 Posted October 2, 2013 I hear you! Me too my deductible and OOP are met for the year! Share this post Link to post Share on other sites
shelley_38 10 Posted October 3, 2013 I am patiently waiting to hear back from Aetna about my surgery. The waiting is driving me crazy !!! Share this post Link to post Share on other sites
nh20013 15 Posted October 3, 2013 I know how you feel I am submitting my appeal tomorrow and will have to start all over with the waiting game hopefully the review of an appeal doesn't take as long! Share this post Link to post Share on other sites
shelley_38 10 Posted October 4, 2013 What do you have to include when your doing an appeal? Did your surgeon do a peer-to-peer review with the medical director before having to do an appeal? Wanted to get a jump start in case I get denied. Thanks for any information anyone can give me! Share this post Link to post Share on other sites
nh20013 15 Posted October 4, 2013 Yes they did a peer to peer and it was denied too... Just from the different post I've read I wrote my own letter, also had my PCP write a LMN and submitting my sleep study results .... If anyone else has any suggestions please let me know I am going to submit tomorrow!! Share this post Link to post Share on other sites
mazzers120 75 Posted October 4, 2013 Yes they did a peer to peer and it was denied too... Just from the different post I've read I wrote my own letter' date=' also had my PCP write a LMN and submitting my sleep study results .... If anyone else has any suggestions please let me know I am going to submit tomorrow!![/quote'] Did you have sleep apnea? I'm doing my sleep study tonight. This is becoming a really long process Share this post Link to post Share on other sites
nh20013 15 Posted October 4, 2013 Turns out I did have it had to do a second sleep study with the CPAP ... Wish the surgeons office would have suggested I do it before my denial ... Trust me I know it's frustrating I completed my 90 day period on 8/16 and was so excited thought I would be sleeved by now. Share this post Link to post Share on other sites
nh20013 15 Posted October 4, 2013 I have Aetna POS II plan. My BMI is 39.7 and I have high blood pressure and sleep apnea. My info was submitted to Aetna on Wednesday and I called today and it is still pending but they did tell me it was being currently reviewed by the nurse. I wish I thought of submitting a letter with my file. I guess if I need to appeal I can include one Have you heard back ? Share this post Link to post Share on other sites