Aetna Help!

[Westfield27 54]

I am currently on my last month seeing my nutritionist for the 3 month program required by Aetna for WLS. So far all together I have gained 4lbs over the two months I have been seeing her and have yet to lose any.( I started at 391.6 my last WI was 395.6). I explained to my nutritionist that I was experiencing Water retention thus the reason for my weight gain. I struggle with PCOS which I've learned also makes it hard for me to lose weight. Last week I also found out that I may have ovarian cancer which my GYNO says is due to my size. I am currently 26 and on my parents medical plan which will end for me in 2015 so this is my last shot. If I don't get this surgery this year I will not have the opportunity again. I have seen different stories of people being denied due to gaining weight. Can anyone shed some light on this please? If I lose weight this month will I still be approved although I gained weight the first two months?

TIA

[blondiebabs 214]

I too have Aetna, the FL state workers version. You should lose some weight when you do the liver shrink diet. I think as long as you are at least a lb less than you were when you started you will be ok, but I believe from what I have read of Aetna guidelines you can't weigh more than your first weigh in.

I have PCOS as well and my weight can fluctuate 5 lbs one day to the next, the Water retention is the worst. You probably already are, but if not avoid a lot of salt and fat. Drink a lot of Water, I know it sounds weird but when your body is dehydrated it wants to hold onto the Fluid, so when it feels like it's plenty hydrated it will release the Fluid. Walking 2-3 times a week for 15-20 mins helps me too. Try to schedule your appointments a few days after TOM, because if you go the week before or the week of that seems like when the water retention is the worst.

Edited June 12, 2014 by blondiebabs

[Westfield27 54]

I too have Aetna, the FL state workers version. You should lose some weight when you do the liver shrink diet. I think as long as you are at least a lb less than you were when you started you will be ok, but I believe from what I have read of Aetna guidelines you can't weigh more than your first weigh in.

I have PCOS as well and my weight can fluctuate 5 lbs one day to the next, the Water retention is the worst. You probably already are, but if not avoid a lot of salt and fat. Drink a lot of Water, I know it sounds weird but when your body is dehydrated it wants to hold onto the Fluid, so when it feels like it's plenty hydrated it will release the Fluid. Walking 2-3 times a week for 15-20 mins helps me too. Try to schedule your appointments a few days after TOM, because if you go the week before or the week of that seems like when the water retention is the worst.

Sad part is I have not had a TOM since 2012 after I had a miscarriage. I just want to make sure I have the least possibility of being denied as possible. This is the last shot I have and it has me nervous and on edge that one little thing may screw it all up.

[blondiebabs 214]

Ugg I know that feeling, I had to be put on BC to regulate my TOM because sometimes I wouldn't have it for a year or more and it wasn't a good thing, but I'd still have insane pms symptoms. Has your PCP tried metformin on you? I'm not a fan of it, it doesn't really help me lose a lot of weight fast, however I've slowly lost a few lbs on it and it's kept me from quickly balloning back up if I have a week where I'm not being as good as I should be with diet and exercise. If you aren't on it, maybe they can try it on you for your last month and see if it helps you loose a little to help you with your approval. It does have some nasty side effects, but I've found if I eat healthy and do not overeat then I don't really have the terrible side effects.

[Westfield27 54]

My doctor just prescribed me something called Provera. He said it should regulate me. I take it 15 days out of the month then directly after those 15 days I should get it. I start taking it the 15th of every month so on 15 days off for 15 days.

[blondiebabs 214]

Ok, yeah, that is a hormone replacement therapy. The metformin is actually a diabetes medication that some dr's find helps PCOS patients as well, I take it as well as my birth control, and my OBGYN is fine with me taking it. The metformin helps limit the amount of sugar absorbed into your body, as well as limits the amout of sugar your liver makes. One of my friends with PCOS has had great success losing weight with just that medication, diet and exercise, I'm kind of jealous. lol

[Westfield27 54]

Your friend lost weight with Provera? I was told it cause weight gain.

[blondiebabs 214]

sorry no with the metformin, not provera.

[avs194 3]

I gained and was approved. Am scheduled for July 31

[brown eyed gal 59]

I have Aetna. I went to my initial appointment on July 17, I specifically asked Dr. if I needed to "diet" now. He said no. So... I haven't been eating as well as I normally do. THEN two weeks after I saw the doctor, one of his team, called me to go over info and he told me that I am not to gain ever from my first visit to my last visit. I will be weighed 4 times total, counting first time. I had read that I should not weigh more at my last visit but I didn't know that at each individual weigh in that I should NOT gain weight. So...this next two weeks, I'm going to be super good so that I do not weight more than my June weight when I go in July. Frustrating I wish I would have know this from the very beginning! Wish me luck!

Edited September 6, 2014 by brown eyed gal

[Westfield27 54]

So now I am aggravated. After being told by the nutritionist that me gaining weight wouldn't matter with Aetna apparently it matters. My file was submitted to insurance today and the lady who submitted it called to tell me there was a 90% chance that I would be denied because Aetna has been very anal weight gain. I wish they would have told me this 4 months ago when I started this all. January 19th I will no longer be covered by my parents insurance so it's kind of a countdown to try and get this done. I guess all I can do is pray for the best but I really wish I would have known about this months ago. What was excitement that my papers had been submitted is not dread and anxiousness.

[KSTUZ 438]

Hello all! I was also denied by Aetna for weight gain. I don't know where u all live, but I was given a lil tip from a friend on sending my appeal into Aetna...

CONTACT YOU STATE REP AND UR STATE SENATOR!!

I live in PA, I contacted and emailed my Pennsylvania senator Stewart Greenleaf and emailed him my appeal letter on Monday night.

Today I was received a call from his office stating that they received my request and sen. Greenleaf was writing a letter on my behalf to Aetna supporting my appeal.

Apparently insurance companies DO NOT LIKE THE REPS AND SENATORS involved. HOPEFULLY this will help my appeal!!

I'll let u all know if it works!!

[Westfield27 54]

Hello all! I was also denied by Aetna for weight gain. I don't know where u all live, but I was given a lil tip from a friend on sending my appeal into Aetna...

CONTACT YOU STATE REP AND UR STATE SENATOR!!

I live in PA, I contacted and emailed my Pennsylvania senator Stewart Greenleaf and emailed him my appeal letter on Monday night.

Today I was received a call from his office stating that they received my request and sen. Greenleaf was writing a letter on my behalf to Aetna supporting my appeal.

Apparently insurance companies DO NOT LIKE THE REPS AND SENATORS involved. HOPEFULLY this will help my appeal!!

I'll let u all know if it works!!

I've heard from elsewhere to simply ask your surgeon to call on your behalf and plead your case of how important it is that you get this surgery.

[KSTUZ 438]

They did that- Aetna wasn't budging

Jerks

[Westfield27 54]

Oh man. That doesn't give me hope