YIPPEE!! Just got insurance approval

[bjperkins54 0]

things went exactly as Dr. Champion said they would....Aetna initially did not approve the surgery because my high blood pressure was under control with meds......(Dr. C said they would turn it down and he'd have to get on the phone with them)....sure enough -- he did a peer to peer -- and they called to say they've reversed their decision. Just waiting on the official letter now to schedule surgery!

[oneflew 0]

Congrats bjperkins!

You must be so excited!!!! Any word yet on surgery?

Congrats again!

Sam

[bjperkins54 0]

Yes -- scheduled for Nov 12! Was surprised I could get on the schedule that quickly. So I'm now on my pre-op diet -- which basically just consists of cutting out carbs,sugar and reducing caffeine. So not too bad. Do my pre-op visits on 11/10 --surgery on11/12!

[oneflew 0]

Wow!!!!! That is fast. You must be super excited. Not too bad on the pre op diet, some folks have had to do drinks or Atkins or something very restrictive.

Yay for you!!!!!!!

Sam

[Kellster 1]

Congrats on approval!

I will have Aetna after the 1st of the year and am trying for approval through them. What did you do to make sure you were approved? Any tips are appreciated, the world of insurance is confusing and frustrating!!

TIA!

[bjperkins54 0]

Aetna requires that you go through a nutrition program with a licensed nutritionist (6 visits) -- I've been working on this since March....went through it via my surgeons office and lost 20 lbs during that 5-6 or months. They also want proof that you've been overweight for at least 2 or 3 years -- I just provided them the last 3 years medical history which showed my weight on each visit to the doctor. But, since my BMI is < 40, they initally turned me down because my BP is under control with medication. Dr. Champion then had to do a peer-to-peer call with the physician that denied approval and they then reversed their decision. Apparently, this is normal with Aetna -- Dr. Champion told me in August that this is how it would play out. Outside of those 2 thing, if the BMI is over 40, apparently approval isn't an issue --it's only when you fall within the 35-40 BMI range that they like to turn it down.

If you have decided on a surgeon already, then use them for helping through the insurance stuff -- Dr Champions office knew what Aetna required, what they would do concerning approval.....and they made sure we had everything covered before we even applied for approval. Makes life much easier!

Edited November 2, 2008 by bjperkins54

[Kellster 1]

Thank you for the info, I feel like I'm on the right path!

I have another detailed question for you - my roommate is BMI<40 and will be trying for approval through Aetna. When you proved how long you've been overweight, did it matter how much you were overweight? She's been overweight a while but not necessarily at this BMI (I think she's at 38 or 39 now). She'll be switching to my PCP soon so I'll tell her about the peer-to-peer conversation and hopefully that will help her.

*sigh* Gotta love the obstacle course of ins approval!

[bjperkins54 0]

I don't know on how much overweight -- since my weight has been at a BMI between 35-40 for a few years, every weight I turned in qualified me for this BMI range. But you must have 1 co-morbidity problem if you fall within that range....mine is BP. I know sleep apnea and diabetes are 2 others -- I can't remember what the 4th one is.