Waiting for insurance approval (once it's submitted)!

[dglaeser 0]

Yep, I finished my 3 month supervised diet and exercise on 5/9/08. My final appointment was delayed until 5/13/08. All the weight lost on my ticker so far (37 lbs) was from those 3 plus months. The doctor's office was supposed to submit for approval last Wed, but when I called today, they hadn't done it yet.

I was really hoping to have the surgery done before our trip to the Rocky Mountains in July so that I was past the mushy stage (6 weeks post op), but now that will be impossible. Who knows when I will get approved by Aetna. This means I will have to wait until Aug at least since it will be tough to take off 2.5 weeks for vacation and then turn around and take another week off of work.

Needless to say, I'm very frustrated and depressed today. The past few months haven't been very easy, I've been hungry a lot, but stuck with it. I know I can continue, but the band is a tool that can help me get through the rough spots.

I lost all the weight by watching calories, fat, and carbohydrates in addition to doing cardio for 30-50min 3-5 times per week.

I'd love to be an athlete again like when I was younger.

I guess I'm just ranting, no questions or answers today!

[Flowerpurr 0]

Wow sounds like we are going through the same thing almost. My Dr.'s office finally submitted after three weeks. I have been done with my three month diet for almost a month. I did lose 36lbs which is good. I also have Aetna and they are giving me the run around as to where my file is and what they are waiting for. They say they need more info but the nurse said they have everything they need and like to send people on a wild paper chase to delay the process. I don't know if this is true. Good luck and keep me posted on your progress.

[dglaeser 0]

Yep, sounds like we are in the same boat. Usually, the Dr.'s office is very responsive and good about insurance submissions (at least that's what I've been told). I just found out today that the main office person is no longer there. Just feels like one road block after another.

Keep me posted on your progress too!!

[cakegal 0]

I have my last appointment 5/30. I was afraid of the same thing, until I was recently given what I thought was some good advise. Go to the receptionist and request a copy of your medical records for the time you need. They may have you sign something but they will give them to you. Ask them to send a copy to your insurance. You can also send a copy yourself, and then keep a copy for your files. this might expedite things quicker. I plan on doing that myself. i think we forget sometimes, that those are our files and we have a right to them ourselves.

[Flowerpurr 0]

I thought about doing the same thing until the Nurse told me not to. She said it could delay the process or even worse get me denied. So I am just waiting to here. I called Aetna today and they said it was done with the nurse and is now going to review where they approve or deny. Which really this has been pretty fast. It was only with the nurse a day so I don't know if that is a good thing or a bad one? I am praying for a fast approval. Good Luck to everyone! This journey will be worth it once we are banded!

[Battlekat1970 0]

Ok we are all in the same Aetna boat.... row! row! row! Fortunately Aetna has been very, very pleasant to deal with. The surgery center where I am having it done.... they are the one's dropping the ball. Strike one... they did not let me know that the original surgeon that I had chosen was not in network for my Aetna plan. Easy fix... picked another doctor. Strike two... one of the techs at the center did not take an accurate height measurement.. what? yes that is what happened. My PCP had me at 5'5" and TLC had me at 5'7". Aetna froze my file until we could re-weigh and re-measure. yup 5'5"... correction letter signed off by doctor. Then the insurance chick waited 4 days to submit... which killed an additional week that Aetna could have been reviewing my file.

First visit with TLC - March 9, 2009

Last visit in 90 day requirement - July 8, 2009

File submitted to Aetna - July 30, 2009

My last call to check status - August 6,2009 ( not approved yet)

When I spoke to TLC and asked them how long it usually takes ... they told me that Aetna has up to 30 days to make a decision but they usually receive and answer within 2 weeks... so I hope sometime next week. I hope we all get approved soon....good luck and if anyone needs to rant or vent... I am here just send me a message. Everyone stay cool.... we will get there :scared2:

[Froggie D 1]

Battlekat, we are in the same boat. :wub:

I started my process in October. Went to a seminar to find out my insurance would not cover until 2009. :sad:

In January I went to see a surgeon who said he took BC/BS. After waiting two weeks, found out that he did not practice at the right hospital, but his partner did. Set an appt with him and then was called and told that he was dropping his privileges at that hospital. :bored:

Mean time I saw the psych doc three times and got my testing done. :tongue:

Called another surgeon who said I had to start over with another seminar. :mad2:

Went to the seminar and started to process only to find out I had to do an 8 week over the phone consultation with a dietician (required by BC/BS). I also had to do two support groups and a face to face nutrition consult (required by the surgeon). :mad:

I finished all this in early June and called to see the surgeon for the first time. Thought I was well on my way at this point.

The earliest appointment was not until July 16. :frown:

The surgeon told me that day (July 16) that they would submit for approval within a week. It is now 24 days later and they still have not submitted.

I called BC/BS and they contacted the surgeon to find out what the holdup was. They said they were just busy.

So here I sit.

I have tried to get ready, however. I have been doing two Protein powder drinks and one lean meat and vegs meal each day. I have lost 15 pounds. I have gotten all my meds in line as liquids or crushables. I have stopped drinking pop and am drinking at least 64 ounces of Water or Crystal Light per day (most days over 100 ounces), I am not drinking with meals and I am eating more slowly.

I want this so bad. Just doesn't seem fair. :cool:

Let me know as soon as you hear about your surgery date. I hope it is soon. I am with you. :drool:

Froggie D

[Battlekat1970 0]

Ya'll I just don't know what to do with myself.... I called Aetna today to get status on my approval......HOLY CRAP!!!!! I WAS APPROVED YESTERDAY!!!!! This whole process has taken a long time but the approval was quite fast Submitted a week and a half ago.... pretty quick....good luck everyone I will keep you posted.... Froggie... keep your head up... have ya'll heard anything yet?

[Froggie D 1]

Battlekat, I am soooooo happy for you! :biggrin:

Do you have a surgery date yet? What are your emotions since you found out? Are you excited or scared or worried or what? What are you doing differently now? What kind of pre-op diet do you have to do?

Everyday I keep thinking "This will be my day." It has to happen eventually.

Trying not to watch the clock as each minute goes by!

Froggie D