Approved by Aetna in 4 business days

[ready2livenow 19]

Hello All-

I wanted to post this as a reminder and to be a positive story within so many insurance denials.

I started my WLS journey in June 2014 with a seminar at the hospital where my eventual surgery will take place. At that seminar, I was provided a check list and a 10 page application to become a patient in the bariatric center. I went to my primary and asked for a letter of referral, a copy of a sleep study I had previously and wrote a letter myself describing why I thought surgery was the best option. I emailed all the info and my application to the center and received an appointment on August 6th to start the preliminary testing and pre-op diet required by Aetna as well as the center.

My BMI at that time was 40 with comorbidities of insulin resistance, PCOS, GERD, sleep apnea and family history of other conditions. I advised the center that Aetna required a 90 day pre-op diet with check-ins every 30 days. I followed the south beach diet and logged everything I ate along with my exercise. I had an endoscopy completed, a psych evaluation and blood work completed immediately following my first appointment.

My 30 day check in, I was down almost 3 pounds and was told that if I was closer to the 5% down (13 pounds) that the center was looking for, I would be able to schedule my appointment with the surgeon after my 60 day check in. My 60 day check in, I was down another 4 for a total of 7 pounds from my initial visit. The nurse practitioner was pleased enough with my adherence and my weight loss to allow me to schedule my surgeon appointment and officially become a member of the program.

*Note: Each 30 day appointment, I met with a nutritionist and the nurse practitioner.

My 90 day check in (early November), I had lost a total of 13 pounds and met with the surgeon on November 11^th. I spoke to the surgeon about the different options and we decided to proceed with the sleeve. During this time, there was a massive storm and the center closed for a few days and my paperwork was not submitted to Aetna until the 24^th of November, the Monday before Thanksgiving.

I called Aetna everyday checking on the status and making sure they had everything. I was a worried mess, I’d read all the posts on here and cry thinking that I was not going to get approved for different reasons.

The following Tuesday morning, December 2^nd, I received a call from the nurse assigned to my file from Aetna advising me that I had been approved for funding and they deemed the surgery medically necessary for me. My smile couldn’t have gotten any bigger. She, also, advised me that it had been approved the day before; so with Aetna being closed for Thanksgiving Thursday and Friday, from submission to approval was 4 business days.

My surgery is scheduled for December 18^th and I couldn’t be more excited to start the next chapter of my life. The healthy chapter. I attribute my quick approval to being vigilant and documenting everything along the way. I completed all the tests quickly and made sure that I followed all of Aetna’s requirements along the way.

[Elode 8,093]

Congratulations

[ready2livenow 19]

Thank you!

[Elode 8,093]

You're welcome!