DENIED by Aetna today :(

[KSTUZ 438]

So after 6 months of tests and appts I was called by the nurse at my surgeons office to tell me that my surgery was denied.

I am HEARTBROKEN. ????

I have been though so much this year.

As I started this journey, one month in, my 37 year old husband had a heart attack. Which then required a triple bypass because of 3 blockages. We made it through 20 days in the hospital, 6 days in the cardiac ICU.

We both quit smoking, and I was determined to keep going forward with this. I kept my appts and tests even with him in the hospital. Just so I could have this done and we can BOTH start our new lives together.

Because when he was in the hospital I could barely BREATH let alone eat. I lost 15 pounds.

Now because I quit smoking and my husband is recovering slowly but is recovering nicely, I began to eat. I'm starving. I'm following exactly what I should and I put on 10 pounds. I started a celexa for depression and blood pressure meds a few months ago.

I was denied because of the weight gain through the 3 month nutrionalist appts.

I am so sad, I am so depressed.

I feel defeated.

I plan on appealing. I don't know how to pick myself up from this.

Thanks for reading, advice would be greatly appreciated.

Katie

[BeagleLover 1,020]

I definitely would appeal, citing the extenuating circumstances. Don't give up!

[Cmoore254 6]

My heart and prayers go out to you. When you stop smoking your heart rate slows down and you burn less calories (so I have been told). I hope that you can find a way to appeal.

[kelew39 64]

I'm sorry to hear that. I'm glad your husband is doing better. I have Aetna myself. I'm nervous about gaining. I stopped taking my blood pressure pills/water pills. Once I started taking them again, I lost 7 lbs in 2 days.

Maybe you can go to one more month of nut visists and submit it agin with the last 3 months.

Good luck!

[skinnygirlwithin 693]

1st - i am happy to hear your husband is getting better...

2nd Appeal! In Oct of 2013 I got sick with bronchitis and I couldn’t shake it… I was put on steroids for almost 4 weeks… (we all know what steroids do…) anyway I gained about 15lbs and come Nov when my doc office sent in my paper work, I was denied due to the weight gain. My doc office appealed before I even knew about it and got approved. My surgery was Dec 11^th of 2013.

DON’T GIVE UP!!! Write a letter, make phone calls… DON’T GIVE UP!!! KEEP APPEALING till you get a YES!!!!

Good luck!!!

[AngryViking 217]

Sorry about that, Katie. That really stinks. However, typically the denial letter will outline exactly why the insurance is denying the procedure. Did the letter give you any guidance as to what more they're looking for? Hopefully your surgeon's office will assist you with the filing.

[InfiniteButterfly 438]

Good luck with appealing And I'm not familiar with Celexa, but does it cause weight gain? I know a lot of anti-depressant and anti-anxiety meds can cause weight gain (giving good grounds for appeal). Plus with all the other stressors?

[tattoogirl233 9]

So after 6 months of tests and appts I was called by the nurse at my surgeons office to tell me that my surgery was denied.<br><br> I am HEARTBROKEN. ddc94<br><br> I have been though so much this year. <br> As I started this journey, one month in, my 37 year old husband had a heart attack. Which then required a triple bypass because of 3 blockages. We made it through 20 days in the hospital, 6 days in the cardiac ICU. <br><br> We both quit smoking, and I was determined to keep going forward with this. I kept my appts and tests even with him in the hospital. Just so I could have this done and we can BOTH start our new lives together.<br><br> Because when he was in the hospital I could barely BREATH let alone eat. I lost 15 pounds. <br><br> Now because I quit smoking and my husband is recovering slowly but is recovering nicely, I began to eat. I'm starving. I'm following exactly what I should and I put on 10 pounds. I started a celexa for depression and blood pressure meds a few months ago. <br><br> I was denied because of the weight gain through the 3 month nutrionalist appts.<br><br> I am so sad, I am so depressed. <br><br> I feel defeated.<br><br> I plan on appealing. I don't know how to pick myself up from this.<br><br> Thanks for reading, advice would be greatly appreciated. <br><br> Katie

I got denied the first time also! Sometimes it is just paperwork not submitted correctly!!! Keep on trying!!!!

[Anabanana34 2]

Don't give up!!! Appeal...appeal...appeal and never take no for an answer!!! I had the lap band done in 2006 and it broke and slipped in the last 4 years and I gained all the weight I had worked so hard to get off back...mind you some of it was my fault. I initially was denied 2 years ago for the conversion and as does with us all...life happens...and I had to end up getting a bone transplant in my ankle from an old injury...well needless to say, I started back on the journey to have this defective band removed and a conversion to the sleeve process about a month ago just knowing they were going to deny me...and I was prepared to fight tooth and nail for my life...well this time around I was approved and am scheduled for surgery August 29th.

So stay focused on your journey to a more healthier you and we are all hear for you!!!

[LumpySpacePrincess 594]

Celexa is notorious for causing weight gain. Your surgeon's office should be able to appeal successfully showing that your weight gain coincided with the start of the Celexa.

That being said, it might be worth it to look into other medications that are less likely to cause weight gain so you're not struggling after surgery. I'd also avoid Zyprexa for the same reason, but you might try Paxil if you are taking the medication for anxiety/panic attacks. If you need medication for depression, try Wellbutrin or Luvox but I'd stay away from Effexor (very strong and hard to get off of), Zoloft and Lexapro. All of those are known to cause a lot of weight gain.

I hope this helps and you get approved soon!

[InfiniteButterfly 438]

Ugh, I know I gained on Zoloft. I went up nearly 30 lbs (that was the straw that broke the camel's back as far as me starting the process for surgery)

[ren0318 81]

hum you would have thought your case worker would have known the requirement and ensured to had met them all before submitting. That's is such a bummer to get you excited about the submission only to be denied. I started my journey last August and still have not had my surgery, I had a medical ER in January and that messed up everything! I have to redo my psych apt, cause it's now over 6 months old I have Cigna and they require it to be 6 months or less, my plan didn't call for weight loss just a supervised weight management plan. I agree with whoever said find out specifically what they need you to do and get busy. You can do this!!

[HalloweenBaby24 447]

I'm so sorry you're going through all this..
Don't give up "Just Keep Swimming" and defiantly ask you're surgeons office to send in an appeal.

[Westfield27 54]

This scares me . A lot of people have been denied due to weight gain in the NUT program. I have my last NUT appointment tomorrow and I have gained every month. have Aetna, but I was never told I needed to lose weight. This month will be no different considering my doctor has put me on a hormone pill and I have gained crazy amounts of weight in just 3 weeks on it. I get more and more anxious about all of this every day.

Edited July 9, 2014 by Westfield27

[KSTUZ 438]

Hello all, I just woke up from a longgg nap. I think I was completely emotionally drained.

I thought the phone call was to schedule and to find out it was denied. At that moment was just too hard to handle.I'm still heartbroken.

I thank you all for your kind words of encouragement. I needed it.

I will keep fighting, I will not give up.

I didn't receive my letter yet in the mail. Once I get that, I can start the Appeal process I guess.

Keep u posted. And thanks again.