First Appeal-DENIED.

[KSTUZ 438]

So after getting denied by Aetna for a "net gain" during my husband heart attack and triple heart bypass, I appealed....and was denied again.

I don't even know where to pick up and start now.

I sent in all of his discharge paperwork so they knew I wasn't just making excuses. And I'm not. I know I messed up. I know I gained. I know how to now fix this. But I'm lost on moving on to my second appeal.

I'm depressed, severely.

I'm miserable.

My husband is ready to kill me I think. I'm crying all the time and I just wanted this for myself so bad.

I know I have to get over my "pity party" and start fighting but honestly I feel lost, alone and just really down. Almost like I don't have fight left in me.

Help.

[GummyTummy 154]

First of all, if that is you in your picture, you are gorgeous. Second off, it is the insurance company's job to avoid shelling out money for people. I suggest going out and finding yourself a couple of co-morbidity issues for the insurance company. Do they want to pay for high risk pregnancy,( not suggesting you get pregnant to scare them, but the thought of it should) would they like to pay for diabetes medication for the rest of your life or high blood pressure etc? Use these items to argue your point. Check your blood tests and make sure there is no underlying thyroid disease etc.

NO ONE WILL FIGHT FOR YOUR LIFE LIKE YOU CAN AND WILL! You cannot give up. I had no insurance, no job, and am a full time college student at 32 and got care credit to finance the surgery for the sake of my life. Don't let some asshat behind a desk decide how worthy you are of this live saving and giving procedure.

Make sure you are documenting everything. Make sure they know the entire point of having weight loss surgery is because NOTHING else has worked before and you NEED this tool to aid you.

I am sorry about your husband but as I am sure you took care of him during his heart condition, this is your heart condition and he needs to get supportive or else!

There are plenty of people out there just like you fighting. You aren't alone. Keep us posted.

[ProudGrammy 8,322]

denied by Aetna for a "net gain"

@@KSTUZ

sorry about your problem

proof that you have been going through hard times with "life" doesn't mean squat to an insurance company

you had a 6 month supervised diet - and you gained alot??? how much??

now lose the proper amount of weight - even if that means 6 more month program

this time you MUST lose the required weight, or more to hopefully be approved

success will show them that you WIILL work hard

they just won't be wasting money approving you, and you can't comply with losing weight

if this 6 month is the route you must go, i know thats a pain and "oh no, 6 more months)

what is 6 month when you are referring to an improved lifestyle - health, happiness

best of luck to you

kathy

Edited August 22, 2014 by proudgrammy

[KSTUZ 438]

I have high blood pressure, high cholesterol, depression, at times severe edema in both ankles. So I am being treated for all of the above. I started at 303. Then my husband had a heart attack, between being in the hospital for 18 days including his bypass, i barely ate. After I went back to work and was almost done caring for him. I smell food and gain. But I fluctuate awful. I have been going to 3 more nut visits but I had to cancel August because of my work schedule. I'm calling every morning to see if there are any cancelations. Thank u all for ur support and giving me ur thoughts. I am doing 3 more months, if I have to start over so be it. Like Grammy said, what's another few months for a lifetime of happiness and health!! I'm just so down. Thanks again guys

Edited August 25, 2014 by KSTUZ

[peteyrulz 82]

I am so sorry you are going thru this. I don't know what your BMI is....if it's over 40 may I suggest you contact Lindstrom advocacy group. (wlsappeals.com) They will gladly give you a free consult over the phone, and if they can handle your case they charge a flat [low] fee. Nothing ventured, nothing gained. ???? They have helped many on BP. I talked to Kelly, she was very helpful even though they did not take my case.

Good luck to you, don't give up!!!

[KSTUZ 438]

I am so sorry you are going thru this. I don't know what your BMI is....if it's over 40 may I suggest you contact Lindstrom advocacy group. (wlsappeals.com) They will gladly give you a free consult over the phone, and if they can handle your case they charge a flat [low] fee. Nothing ventured, nothing gained. dde09 They have helped many on BP. I talked to Kelly, she was very helpful even though they did not take my case. Good luck to you, don't give up!!!

Hi peteyrulz, I just got off the phone with Kelly. She was so nice. May I ask you why she didn't take ur case? Where are you now with everything? Did u get approved??

[tnl1031 52]

Thinking of you Katie, hope you can get it worked out Hang in there, you've made it this far, you can make it another 3 months!

[peteyrulz 82]

I am so sorry you are going thru this. I don't know what your BMI is....if it's over 40 may I suggest you contact Lindstrom advocacy group. (wlsappeals.com) They will gladly give you a free consult over the phone, and if they can handle your case they charge a flat [low] fee. Nothing ventured, nothing gained. dde09 They have helped many on BP. I talked to Kelly, she was very helpful even though they did not take my case. Good luck to you, don't give up!!!

Hi peteyrulz, I just got off the phone with Kelly. She was so nice. May I ask you why she didn't take ur case? Where are you now with everything? Did u get approved??

Hi Kstuz...They did not take my case because my co-morbidities were not what was required by my insurance with my BMI of 38.86 & I don't have diabetes, HT, etc. I am jumping thru some hoops & I've switched surgeons; my new surgeon's staff is more helpful. Submittal to insurance will hopefully be this week or next. Fingers crossed!

[jessdawn37 27]

KSTUZ....I've been thinking about you. Any luck with your appeal?

[KSTUZ 438]

KSTUZ....I've been thinking about you. Any luck with your appeal?

Hey! Thanks for thinking of me

I hired lindstrom appeals, I faxed everything last week. Waiting on hearing back from them.

So fingers crossed they will fight this for me!

[Jersrose43 837]

Hey! Thanks for thinking of me I hired lindstrom appeals, I faxed everything last week. Waiting on hearing back from them. So fingers crossed they will fight this for me!

Do they charge for this? I wish you best of luck

[jessdawn37 27]

I didn't even know you could hire a company to appeal for you....that's awesome! I hope they didn't charge you too much, but then again you can't really put a price on your health. Hope it all goes well for you!

[KSTUZ 438]

Hey! Thanks for thinking of me I hired lindstrom appeals, I faxed everything last week. Waiting on hearing back from them. So fingers crossed they will fight this for me!

Do they charge for this? I wish you best of luck

Yeah they do charge, one flat rate for whichever package u choose. I'm still in the beginning stages of appeals. So they take my second appeal and on. So if it continues to be denied they keep fighting for you until u get approved, still a chance it could be denied, they don't make any promises. They were awesome so far!!Www.wlsappeals.com.Here goes nothin!!!

[KSTUZ 438]

I didn't even know you could hire a company to appeal for you....that's awesome! I hope they didn't charge you too much, but then again you can't really put a price on your health. Hope it all goes well for you!

Thank you! It wasn't cheap but like u said, can't put a price on it. I paid for the expedited service, so after they receive all my medical files they have 3 days to submit to Aetna. I didn't know either! Thank god for this website. A few had recommended them. So all I have to do is pray to god that they can get it overturned.

[rustypickerd 12]

Good luck. I have Aetna...I really thought I would be denied. The surgeon submitted my paperwork on Thursday, and Aetna called and approved yesterday. I hope things work out for you!