Help. Becoming Hopeless

[jhammer2 8]

Help! In January my insurance (Aetna) declined my pre-authorization for the surgery because I had gained a few pounds (on and off, 5 at the most) during the 6 month diet monitoring period. They told me I would have to start my 6 month diet monitoring over again and resubmit. My 3rd appt for the second 6 month monitoring period is coming up and I'm up in weight from last month. I have been sick and not able to stay on top of the dieting and exercising recently. I am feeling better now and have started with the diet and am joining a gym tomorrow, but I fear it might be too late.

I started this process last June and I am losing hope that this will ever happen. Has anyone else gone through something similar? Any suggestions on how to hang on or keep hope?

Thank you!

Jenna

[Ashlei Thomas 7]

Consider doing the pre op all liquid diet. I lost 15 lbs in 2 weeks and gives you training for post op. Google pre op liquid diet and meal and will show up.

[Crosby 303]

Aetna only has a " net " loss requirement so unless you gained from your initial weigh in weight I don't understand why they would deny you. I gained twice during the 6 month review period but overall had a loss. I was approved in less than 24 hours. I know several others who did the same? I would clarify reason for denial. as far as current problem with gaining perhaps you need additional support. I know it is tough but it is tough after surgery too so don't give yourself the okay to go off the wagon.

[Mommabird 367]

I have Aetna and managed to get approval first time out. To lose my weight, I used a modified version of my pre-op diet (protein shakes (4 a day) and non-starchy veggies). I added limited amounts of lean meats and fruit. I also upped my exercise. It wasn't easy. But I lost the weight Aetna wanted and had approval in less than 12 hours.

[Jersrose43 837]

It's a net gain but some employers have additional stipulations tacked on. I hate aetna. You can actually lose no weight and get approved but gain a pound and you're done.

[Jersrose43 837]

I would give serious thought to an appeal. Send in medical records for last couple years especially if you can show it was a momentary lapse