Submitted to Aetna Ins for Revision Surgery

[PSUCookie 0]

Hello!

I am new to the forums. I will be sharing my story in a different forum later tonight. Right now I have a question for anyone who may have had a revision done to your gastric bypass. I followed Aetna's requirements:

• 90 Days with surgeon (weight management)
• Visit with nutritionist
• Visit with mental health provider
• Visit with a local exercise facility (3 visits prior to submissions)
• Chest x-rays, blood work, sleep study, and a few other items (cant think)
• write a personal letter

My surgeon's office was I believe submitting either last Friday or Monday. I successfully lost 6lbs during the 90 days (mostly Water weight).

I was curious who got denied, or who got approved and how long did it take.

Thank you!

~ Cookie

[PSUCookie 0]

So, I got an email response from Aetna, can anyone provide some insight? To me it seems like they might deny it. I should also say my surgeon's office never contacted me for additional information. Should I be concerned.

~ Cookie

Your request
Your precertification request, authorization number ########, is
pending.

On November 16, 2015 a letter was sent to the requesting provider
stating we needed additional information to make a decision. We
requested the following information:

Clinical documentation appropriate for the procedure, such as diagnosis,
medical history and physical, symptoms, relevant medical chart records,
results of appropriate imaging modality, results of conservative
management, Photographs, functional assessment etc.

Once our Precertification Department receives the additional information
they will be able to make a determination.

Edited November 20, 2015 by PSUCookie

[dede0314 356]

To me it seems like your doctor's office did not send all the required documentation. The doctor's office should send all the clinical notes from all your visits especially the NUT visits.

[PSUCookie 0]

@@dede0314 That would make sense, that seems a little discouraging because they said they will send everything up.

Thank you for your response.

[PSUCookie 0]

Got an email from Aetna that they got the additional documentation today and its in review (7-10 days). I wont count on hearing anything until after Thanksgiving. Hopefully the have what the need and will consider my request for a revision.

Thanks!

Edited November 20, 2015 by PSUCookie

[Emilee68 46]

Got an email from Aetna that they got the additional documentation today and its in review (7-10 days). I wont count on hearing anything until after Thanksgiving. Hopefully the have what the need and will consider my request for a revision.

Thanks!

Hi there! I am waiting to hear from Aetna on my sleeve to bypass revision. I called today and they said it's in review as of the 26th. Said it could take 7-10 days. Just curious...were you approved? How long did it take to hear back for a final decision?

Sent from my SAMSUNG-SM-N910A using the BariatricPal App

[dede0314 356]

Any update ?

Sent from my iPad using the BariatricPal App