Could Aetna deny me?

[CaliRey95 7]

Hello everyone, I'm scheduled to have the gastric sleeve surgery May 1st. It's been a very long process. I started with my primary care physician in October. So it's been roughly 6 months, and I also saw a nutritionist the last three.

I've completed every single step in the guidelines. EKG, X-RAY, LABS, Endoscopy, supervised diet 3+ months, psych eval, and weigh ins with PCP for 7 months total. I also have history of obesity since 2015.

Starting weight was 256 and current weight is 248. My liquid diet starts 4/17.

With that being said, I've spoken to my insurance numerous times over the last week just to get a general idea and they're pretty vague.

What are your opinions on my chances of being approved? It was denied once due to lack of documentation. My PCP submitted too soon.

Any May Sleevers out there?

[aNYCdb 310]

I can’t speak to chances of approval, but most of the time you aren’t getting scheduled if the surgeon’s office doesn’t expect you to get approved.

[BGrundee 61]

I have Aetna and just finished my 90 day regimen. It was more like 94 days because I had a 4th visit to do as well. My paperwork/report was completed today and sent in. My bariatric weightloss center will not schedule anyone until there is a confirmed approval from Aetna. Once approved for surgery and recieve a date, thats when I will have to schedule EKG, X-RAY, LABS and make sure its all done before the surgery date.

I think your pretty set. If you do not get approved its because your plan does NOT cover it. If you've come this far, why would they stop you now. It just doesnt make sense.