Waiting for Approval

[alaskansleeved4me 4]

So my surgeon office has been playing games about submitting to my insurance which is Aetna ????, and I am so confused, I have been speaking with a surgeon office in Vegas and they were told by Aetna that I only needed 4 months diet program with my doctor and a ekg, ultrasound, upper gi and phys evaluation and clearence from my doctor, but the surgeon here in Alaska stated that I needed 6 month diet program with my doctor. So I am so confused... any insight would be wonderful and helpful.. I am very nervous that they are going to denie my approval because the surgeon here submitted today with 5 months and all the testing. I also have sleep apnea, chronic high blood pressure, pre diabetic, and bmi of 45.5..

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[jane13 2,256]

@@alaskansleeved4me - found out what your insurance requires and go from there.

Have you got documentation for weightloss that is recent? Like Weight watchers? Gym membership with trainer?

Maybe another type of doctor you have seen for the pre-diabetes can provide some weight loss documentation, even if you didnt succeed.

Good luck!

[alaskansleeved4me 4]

@@alaskansleeved4me - found out what your insurance requires and go from there.

Have you got documentation for weightloss that is recent? Like Weight watchers? Gym membership with trainer?

Maybe another type of doctor you have seen for the pre-diabetes can provide some weight loss documentation, even if you didnt succeed.

Good luck!

I have read through my insurance clinical policy like 100 times and it's not really clear to me what their requirements are ????.. I have called them like a thousand times and they can never really give me a full answer.. I have all kinds of weight loss program stuff that was turned in.

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[findingnish 39]

So my surgeon office has been playing games about submitting to my insurance which is Aetna ????, and I am so confused, I have been speaking with a surgeon office in Vegas and they were told by Aetna that I only needed 4 months diet program with my doctor and a ekg, ultrasound, upper gi and phys evaluation and clearence from my doctor, but the surgeon here in Alaska stated that I needed 6 month diet program with my doctor. So I am so confused... any insight would be wonderful and helpful.. I am very nervous that they are going to denie my approval because the surgeon here submitted today with 5 months and all the testing. I also have sleep apnea, chronic high blood pressure, pre diabetic, and bmi of 45.5..

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I have aetna I'm located in Louisiana I was required to do the six month supervised diet I finally had my surgery Tuesday may 17, 2016 it's be a long time coming but I finally did it

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[smgarsee 9]

I have Aetna and located in Missouri. My plan required a 6 mo medically supervised diet without a net gain from start to finish. I had no trouble getting approved. I understand there are different tiers when it comes insurance, so it's possible to have different requirements. I was sleeved on May 9th and had my first follow up today. Everything looks great and progressing well. Moving on to the next phase.

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[Kendell Thatsme 39]

I'm having the same problem so frustrated i dont understand it. I'm suppose to have my surgery july 25th which will be 3 months my nutritionist scheduled all 6 of my appointments in that time frame.So now not sure if its 6 months with 6 visits or 6 nutritional visits in total called my insurance got no help not sure if i will have my surgery in july or have to wait 90 days more.????

Insurance policies need to make things more clear.

Edited May 24, 2016 by Kendell Thatsme

[aslcertified 86]

_{Good Morning everyone! I needed some feedback and support regarding insurance not paying for bariatric surgery, I also have Aetna POS here in Louisiana and I too went through the 90 day program one of Aetna requirements, I fit all of the criteria and just last week received noticed I was denied because I gained 1 lb and did not schedule my procedure within 6 months of my initial start date. I was in shock, upset, and very disappointed. how can this be, initial program date 6/25/15 last weigh in date 9/16/15 and immediately was denied, I researched and hired obesity advocate /attorneys to fight this since Dec 2015 to start the first appeal process and last week the appeal was denied because I gained 1 lb. I do not understand that policy, I weighed in summer which means my clothes were lighter, then last weigh in was September which my clothes would have been a little heavier 1 lb is not a significant amount of weight to consider because 1 to 2 lbs can come from many factors such as clothes, time of the month, or if I had a snack or lunch prior to the appointment my clothes alone would weigh 1 to 2 lbs COME ON'. I can understand if I gained 5 lbs to 10 lbs of weight. OMG!! I want to scream...... Has anyone experienced AETNA denying surgery for weight gain and then was approved after it was appealed first or second time? Now we are going for round 2 and want to know if it is worth it bec I am so disappointed with Aetna. HELP!! please ADVISE!!}

[aslcertified 86]

does anyone know, if the denial is upheld how long do a person have to wait to start the process over again?