I was denied!

[Jersrose43 837]

This doesn't sound Kosher. I would ask your surgeon to request a peer to peer review. Or review what they submitted showing you did indeed lose steadily. Did they not show the net LOSS?

sorry this isn't making sense. I know they're crazy but this is odd

[Lorraine M 0]

My Aetna policy (as explained to me by the nurse at my surgeon's office) was that if anytime I weighed in at their office I weighed even one ounce more than the previous weigh-in I would be denied surgery and have to start over. I was told they implemented this "hoop" for us to jump through back in 2013.

[michellew1 72]

What does your surgeon's office say? That doesn't make sense. You demonstrated you can follow the plan. I would not have needed the surgery if I could have steadily lost weight. Is there an appeal process?

There is an appeal process. They call it peer to peer. But once you do that and if they deny again then it is final. No surgery at all.

[michellew1 72]

I have Aetna as well. During my consultation visit the nurse told me 3 times that if I gain an ounce at all during any weigh-ins at their office I would be denied by Aetna. I would do low carb, high Protein for a week or two before each weigh-in to make sure I was down.

The only time I was worried is when my final nutrition class was on a Tuesday and my follow-up with the surgeon was on a Thursday. I had to maintain or be lower than the Tuesday weight for my visit on Thursday (2 days later) so I kept it light Wed and didn't eat or drink before the Thurs appt to be safe.

I am glad they were up front with you. Mine didn't worry about weight loss, just that I didn't miss an appointment.

[ready2B 263]

That's terrible! So, if you go another month and lose this time, does that count as your 6-months and you can apply again?

[Lorraine M 0]

I am glad they were up front with you. Mine didn't worry about weight loss, just that I didn't miss an appointment.

It sucks they didn't tell you. I hope you can get it appealed.

I know others in my nutrition classes were shocked with how strict Aetna was.

[michellew1 72]

That's terrible! So, if you go another month and lose this time, does that count as your 6-months and you can apply again?

Yes. I have to weigh in on Monday and then again in October then I can submit everything again. Hopefully I have lost more this month. Every time I go to the bathroom I weigh myself. And it is always different.

[Ginger Snaps 1,323]

Yes. I have to weigh in on Monday and then again in October then I can submit everything again. Hopefully I have lost more this month. Every time I go to the bathroom I weigh myself. And it is always different.

One piece of advice... try to get your appointment scheduled as early as possible in the morning and that morning, don't eat or drink anything before going. I can weight as much as 4 pounds less earlier in the morning than later in the day.

[michellew1 72]

One piece of advice... try to get your appointment scheduled as early as possible in the morning and that morning, don't eat or drink anything before going. I can weight as much as 4 pounds less earlier in the morning than later in the day.

Thanks. I will do that.

[michellew1 72]

Yay!! I lost 3 more pounds. One more visit and then it is all in the insurance's hands.

[michellew1 72]

I had my last weigh in yesterday. I lost another 2 lbs. Everything was submitted to insurance again. Now we wait. Keep your fingers crossed that they approve the surgery. Oh and I just realized that today would have been my surgery day.

Edited October 14, 2014 by michellew1

[Lkk0158 39]

Just crazy...sorry to hear that!

[Lkk0158 39]

Good luck!

[KSTUZ 438]

I was just approved last Friday!!

I did have the Lindstrom Obesity advocates (Kelley and Walter Lindstrom) fight my appeal after my first appeal denial. They submitted it to Aetna (I continued going for NUT visits and weigh in and showed a steady loss) and was APPROVED!!!! Just waiting on a date now!

U can fight it if u get denied. I had a weight gain and no weight for 2013. Still got approved. It's all in the way the appeal is written! Please keep us posted on how u make out!!!

If YA need any info from me feel free to contact me!!!

Fingers crossed for you!!!!!

[michellew1 72]

Thanks KSTUZ for keeping your fingers crossed for me. I have my fingers and toes crossed as well. I am so happy you got approved. My doctor was thinking of fighting but said that if they fought and still lost, then it was final. That they wouldn't ever approve me. I didn't want that. She submitted everything again on Monday, so we will see how everything goes. I am so anxious to find out something.