Pre-submission panic

[BloomingLotus 179]

I have finished my supervised diet and all seems to be in order. My new insurance became effective today, so my submission will be happening soon.

All of a sudden today I flew into a panic: what if I get denied?? I know it sounds silly but I never really considered that I could do everything right and not get approved.

I have Aetna, and I did not gain during my supervised diet, so I'm good on that front. My bmi is still over 40 with my loss so far, and I have no comorbidities.

My biggest concern: my weight history.

I needed to provide a 2 year history, and I know that in 2012 I weighed the least I have in a long time, after doing weight watchers for 2 years. I lost 68lbs (only to gain back 75). The records were sent from my PCP directly to my surgeon so I didn't actually see my recorded weight. I'm really concerned about being denied because in 2012 my bmi very well could have been less than 40.

Has anyone with Aetna had the same issue?

[Elode 8,093]

@@BloomingLotus You should be ok. I needed 2 years of a BMI over 40 and the highest it ever was in that two year was 36. I was approved the first time. Good luck!

[BLERDgirl 6,417]

Don't borrow trouble. If you are denied, you'll appeal. For now just stay positive and focused on moving forward.

[Pac-woman 325]

I wouldn't worry to much about it if I were you. Even though you may have had a BMI less than 40 2 yrs ago, still the factor remains there is an issue. Clearly you did a diet program and gained it back and plus a few more. Also, with the weight now, I am sure you probably have other health factors that will contribute to red flags. samples are " Depression, high blood pressure, swelling, headaches, etc"

The health plans make it a little harder as to falling into the required criteria because they want to make sure that you are a candidate, they are not waste their money on someone who is not going to follow through, plus run any risks. As long as you go through all the steps they require you should be fine.

Believe me when I say, they much rather pay for this surgery and get you healthy, then keeping you overweight and have more issues in the future which inturn will cause you to be a high utilizer of the insurance benefits and that will hurt their profits and margins. (I work for a health insurance plan)

Just make sure you cross your Ts' and dot your Is' and follow the rules. The insurance plans through the year have come to terms with obesity and how it is a deadly disease. The surgeries have been successful for many. The ratio is higher on the positive side.

[BloomingLotus 179]

Thank you everyone for calming me down a bit! I have done everything that has been asked of me and followed my requirements to the letter, so the idea of denial never actually entered my mind until today, but when it did, oh boy!

If you go back 2 more years in history I weighed more than I do now, so it really does show my (lifelong) pattern of lose some, gain some +10.

[BloomingLotus 179]

Approved!!!! I have been officially approved for surgery 1/29!! Ahhhhh!

[mrsmith901 18]

Congrats!!!

[Catherine Gray 11]

Congratulations! !! So excited for you!

[della street 213]

@@BloomingLotus I see you're having sleeve on 1-29 -- I'm having RNY also on 1-29 -- we can count down together ) Congrats!

[BloomingLotus 179]

@@della street - it's so exciting/terrifying! It doesn't feel real! I start my liquid pre-op diet Thursday... I think it might start to sink in then. Do you have a pre-op diet?

[della street 213]

@@BloomingLotus Just a 2-day pre-op diet -- light foods two days before, then Clear Liquids day before. My surgery is sched for 8 am on the 29th -- what time is yours? What kind of pre-op diet do you have to do? And yes, excited! terrified! happy! scared! all of the above! lol

[BloomingLotus 179]

@@della street I actually don't know what time yet. The surgeon's office hasn't actually told me I was approved, I called Aetna to find out from the source! I emailed the surgical coordinator to tell her so she is on the lookout for the paperwork.

I requested the earliest appointment available because I'm epileptic, and my medication is time-released for 12 hours. So if I take it right at midnight the night before surgery, I should be awake in recovery before I'm due for my next dose.

My pre-op is 2 weeks liquid, with up to one cup of non-starchy vegetables per day. I can have up to 5 Protein shakes daily, along with broth. I know it won't be easy so i might have to set alarms on my phone to "eat" or drink Water every so many hours to prevent me from getting hangry! I'm jealous of your 2 days!