Aetna ***

[NikkiRT 265]

Mine is definitely different than this and I don't have an HMO

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[dede0314 356]

Neither do I but there are different plans so as long as you got the requirements from your insurance company you should be fine...

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[josiek1988 70]

I also have Aetna through my employer. I went to the Aetna page and printed the 55 pages on WLS. No where in there does it say that you can't gain any weight. But that is one of the first things the Nutritionist told me. She said that the insurance will deny you for 1oz of weight gain.

Trust your doctor and his team! This is what they do. They won't tell you anything wrong. And they know what is needed and just how to get you approved. They will do all in there power to get you approved. I am a band to sleeve revision who just finished my last Nutritionist appt. losing only 8lbs. Psychological evaluation is July 18. No scheduled date yet and I have no idea what will happen with my insurance but I trust my doctor and his team. Best of luck to you all!!!

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[theantichick 2,204]

In California, once you exhaust your internal appeals with your insurance Company, you can ask for an Independent Medical Review with the Department of Insurance. They take info you submit, as for information from the insurance company and have an independent panel of doctors review the decision. I'm currently going through the process right now. I have Aetna and they denied a non-surgical treatment for severe GERD that occurred after my Sleeve. I've had a few insurance companies and Aetna is by far the worst one to deal with.

I had to file 4 appeals and fight for 8 months to get Aetna to approve a knee surgery I needed. They are awful. But just a caveat about the Department of Insurance for your state... if your employer is what is called "self insured" then they are not regulated by the state Department of Insurance, they are regulated by a federal law called ERISA, and it's incredibly hard to get it overturned in federal court. So find out if your plan is ERISA or not... if you do have the option to appeal to the state board, you have a fighting chance.

[ravensekhmet 12]

Well hello first off i just wanted to tell my story and how upset i am . Well this is now going more then 6 months more then it was suppose to well i did everything by the book from AETNA and well they denied me for gaining 2lbs mind you i was on my menstrual week my luck so nothing i could do about it i was mad but then they told my advocate that i can start from my highest weight 240 and do 3 months more GREAT!!! right? well whatever i completed it on March 18th 2016 and weighted 234 i actually lost some weight and then when i left my doctors office with a positive mind and happy with my surgery date and the day to pick up my shakes and go for my clinical clearance, two hours later i get a call from my advocate saying that he called aetna to submit my papers and AETNA told him that since i was DENIED on Jan of 2016 I HAVE TO WAITE 6 MORE MONTHS TO SUBMIT MY PAPERS AGAIN!!!! Really i was soooo mad soooo mad and well here i am at lost i live in FL i just need to know the TRUTH i called AETNA and can you belive they didn't have answer for me that they will call me back well it's been two weeks now and NO ONE HAS CALLED ME.

Hi, I was wondering was the weight gain at your last app. Or during?

I have aetna too I weighted over my beginning weight my app this month. I have my final check next month and I will definitely be below my original number.

My doc said it was no issue as long as I weight in under the original at the last but I'm still worried.

[SouthernSpinoza 2]

I just went through this entire thread, because I have Aetna as well, which is sponsored through my employer. I have read through all the documents on the requirements, and I am not seeing anywhere that is states there can not be weight gain through the process. Is this something that your surgeon advised you of? I just don't want any suprises:)

I also have Aetna and this is where it's at in their paperwork. You can't have a net gain over the time frame when you're doing your physician supervised weight loss (either the 3 month or 6 month).

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[SouthernSpinoza 2]

I also have Aetna through my employer. I went to the Aetna page and printed the 55 pages on WLS. No where in there does it say that you can't gain any weight. But that is one of the first things the Nutritionist told me. She said that the insurance will deny you for 1oz of weight gain.

Trust your doctor and his team! This is what they do. They won't tell you anything wrong. And they know what is needed and just how to get you approved. They will do all in there power to get you approved. I am a band to sleeve revision who just finished my last Nutritionist appt. losing only 8lbs. Psychological evaluation is July 18. No scheduled date yet and I have no idea what will happen with my insurance but I trust my doctor and his team. Best of luck to you all!!!

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[NikkiRT 265]

Luckily I lost one stinkin pound!!!

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[ZollDoll 21]

I have Aetna and I am scared they will deny me.

I have my Nutritionist visit next week and I am up about 15 pounds from the 1st visit, I was put on a biologic from my Rhumetologist and I had severe Water retention in my legs and feet (she pulled me off the medication) but while I can gain 15 pounds in a week or 2 I sure can't lose that much in that period of time. My feet and legs are ALMOST back to normal so I just hope by my weigh in its not too bad.

I emailed my surgeons office - the coordinator told me as long as I am down by the end of the 3 months - but I know they told me in the beginning I can't gain at all during the 3 months.

I still have to go to Pulmonology and do my stress test/echo for Cardio but I already told my PCP be ready to appeal the denial.

[NikkiRT 265]

I have Aetna and I am scared they will deny me.

I have my Nutritionist visit next week and I am up about 15 pounds from the 1st visit, I was put on a biologic from my Rhumetologist and I had severe Water retention in my legs and feet (she pulled me off the medication) but while I can gain 15 pounds in a week or 2 I sure can't lose that much in that period of time. My feet and legs are ALMOST back to normal so I just hope by my weigh in its not too bad.

I emailed my surgeons office - the coordinator told me as long as I am down by the end of the 3 months - but I know they told me in the beginning I can't gain at all during the 3 months.

I still have to go to Pulmonology and do my stress test/echo for Cardio but I already told my PCP be ready to appeal the denial.

I would suggest that you get the reason for the gain documented by the Pulmonary Doctor and have them submit it will the initial paperwork to Aetna.

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[NikkiRT 265]

I have Aetna and I am scared they will deny me.

I have my Nutritionist visit next week and I am up about 15 pounds from the 1st visit, I was put on a biologic from my Rhumetologist and I had severe Water retention in my legs and feet (she pulled me off the medication) but while I can gain 15 pounds in a week or 2 I sure can't lose that much in that period of time. My feet and legs are ALMOST back to normal so I just hope by my weigh in its not too bad.

I emailed my surgeons office - the coordinator told me as long as I am down by the end of the 3 months - but I know they told me in the beginning I can't gain at all during the 3 months.

I still have to go to Pulmonology and do my stress test/echo for Cardio but I already told my PCP be ready to appeal the denial.

I would suggest that you get the reason for the gain documented by the Pulmonary Doctor and have them submit it will the initial paperwork to Aetna.

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Sorry I meant to say documentation from the Rhumetologist

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[ZollDoll 21]

I have Aetna and I am scared they will deny me.

I have my Nutritionist visit next week and I am up about 15 pounds from the 1st visit, I was put on a biologic from my Rhumetologist and I had severe Water retention in my legs and feet (she pulled me off the medication) but while I can gain 15 pounds in a week or 2 I sure can't lose that much in that period of time. My feet and legs are ALMOST back to normal so I just hope by my weigh in its not too bad.

I emailed my surgeons office - the coordinator told me as long as I am down by the end of the 3 months - but I know they told me in the beginning I can't gain at all during the 3 months.

I still have to go to Pulmonology and do my stress test/echo for Cardio but I already told my PCP be ready to appeal the denial.

I would suggest that you get the reason for the gain documented by the Pulmonary Doctor and have them submit it will the initial paperwork to Aetna.

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Sorry I meant to say documentation from the Rhumetologist

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Thanks

That is a good idea.

I figured my insurance company can see I was put on it (had to get precert for the medicine) but I will get something from her next time I see her to cover my bases.

[dede0314 356]

Yes I agree try to get documentation from your doctor saying the reason for the weight gain... When I appealed and my appeal stated that I gained weight due to medication they denied it and in the letter it stated I didn't have any supporting documentation so a letter from the doc would be good

[aslcertified 86]

I FEEL YOUR PAIN!!!! UGGGGGGGGHHHHHHHHHHHHHH I want to scream !!!!!!!!

Yes,I completely understand the frustration, I too, have been denied in Dec and I hired an advocate to fight this denial. all of my paperwork was submitted with my first appeal and just last week 7/22/16 they upheld the denial even though I have one of the co morbidities listed and I have followed the 3 month program monitoring for surgery. so my advocate called Aetna on a conference call and the Medical general surgeon (who is not a bariatric surgeon) who made the decision to deny my claim was not helpful AT ALL! she just kept reading from a script explaining the details of my policy which we already knew. so finally, Dr says, bec you did not schedule your surgery within the 6 months of your initial start date and you gained 1.5 lbs your claim was denied. start date was 6/25/16 - 9/16/16 paper work submitted for authorization and immediately denied. COME ON' 1.5 lbs, that could be anything from clothing, time of the month ..... anything !!! I can see if it was a significant weight gain like 10 lbs. they need to have more so we are going for a second appeal and I really need to find out if I am spinning my wheels or do I just need to start over... I wish there is something more we all can do to fight the insurance companies to stop denying surgeries for the simplest thing.

[aslcertified 86]

Received message with the net weight gain photo but doing more research and found out by talking with dr office today and they said I did not gain , I actually lost weight start 6/2015 240lb to 9/2015 at 239.5 so I'm not sure what is going on. Maybe Bec The dr office submitted my paperwork to insurance comp two weeks after the 6 month deadline to schedule my surgery , I have no idea.

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