Anyone gain weight and still got approved (Aetna)

[dede0314 356]

Has anyone gained weight during their program and still got approved by Aetna? I've gained weight and my last weigh in is this Friday I'm nervous I will get denied.

[cornhusker 115]

I have Aetna and was told that gaining weight was a deal breaker. It seems ridiculous because the reason all of us are/were looking into the surgery is because controlling our weight is so dang hard. I will tell you this, my surgery was the absolute best thing I've ever done. I'm just under 4 months post op and I feel like a new person. My point is, I would move heaven and earth to get your weight under where it needs to be so you don't disqualify yourself. I'd find out if you can move your appointment back and get serious about trying to get off what you've gained. Also, after surgery the hard work begins. It's not a silver bullet. You've got to be diligent and very serious about eating right, exercising, and following your plan. It could be that you're not ready for this yet.

[CheleLynn45 615]

I had to do a 6 month supervised diet, which was started in Feb, as a requirement with Aetna. The first couple months I lost weight when I checked in with my doc. When I went in May I had gained weight. I had my birthday and fond out that the hospital where my surgery would happen was not under contract with my insurance. I went thru a few weeks of being mad, and upset.

But once I talked with the insurance they said they were renegotiating and might be under contract again. So I continued to see my primary for my check ins just in case, but I didn't move forward with anything that would cost me money.

I then found out early August that they contract was back in place so I moved ahead and finished what I had left to do to submit to insurance which was just my psych eval,

So then everything was submitted and I was approved in less than two weeks. I was never told that I had to lose a certain amount, and I think I ended up right where I was when I first weighed in at my bariatric doctor, or at least within a few pounds.

[dms724 26]

Yes! I have Aetna and had to do a 90 day supervised diet/exercise plan. During that time, I actually gained 5 pounds. Aetna denied me initially. However, my surgeon's office immediately scheduled a "peer to peer" interview with medical director at Aetna to appeal their decision. My surgeon explained that I had a foot injury that kept me from exercising as intensely as originally planned and that I had my period on the day of my last weigh-in. He even had a copy of the weather report from the date of my last weigh in showing it was minus 6 degrees outside to provide evidence that I was wearing layers and heavier clothes!

Needless to say, I was approved within a week of the original denial. I had my surgery two months later- on Jan 12th!

Fight for it, you must be your own advocate!! Good luck!

[dede0314 356]

They just submitted my paperwork I'm so nervous. My doctor noted on my paperwork that I'm on medication that makes me gain weight so hopefully they take that into consideration. How long did you all have to wait for a decision?

[majorsmama 91]

You can't have a net gain so be prepared to have to appeal. Was it really the medication that caused you to gain weight or did you not diet and exercise as much as you should have?