Frustrated beyond Belief

[SAGEBRUSH 0]

I have Aettna Insurance and it does cover the Lapband Surgery. I have done my 6 months at my doctors, had the phych eval, saw the nutrionist, and had all the bllod work done for this precedure. The problem is with my Primary Care physician. Seems the notes she has faxed over to the Surgeon are very sketchy.. Like "was seen here for weight check. Going to have lapband surgery" This was just the appt I had 2 weeks ago.. Some of the notes are ok, but a couple of months are very empty. The surgeons nurse told me this will get denied because of this. I dont know what to do. I have followed everything to the T and made sure my end was fulfilled and now I get hit with this. Has anyone else had this issue and how did you deal with it to get it taken care of. i was so looking forward to this being done next month and now it doesnt look like its going to happen. I am just so frustrated and down about this. :sad:

[baps813 0]

I have Aetna and had issues with them. They tried to decline me although I had very clear proof of my being in a 6 mo. program.

What they'll want to see is AT LEAST 3 CONSECUTIVE months (total of 6) of your weigh ins and BMI. Make sure the dates are clearly marked. Surely you weighed in each time you went to your doctor, so make sure your PCP puts it in report form for you.

DON'T LET AETNA BULLY YOU because they may try. Don't give up if you know you have everything. I called them so much and sent and re-sent the same info highlighting everything for them. When they saw I wasn't going to give up, they pushed it through quickly. GOOD LUCK!

[lindas0809 0]

Hi! This journey is nothing but frustrating for most of us- believe me we can all relate in some respect. I have Aetna and was approved about a week ago with no problems. I did go to my PCP - her notes were what I weighed, a review of my food logs and just generally our discussion of next steps. I also had a letter of medical necessity from her which my surgeon said was one of the most important things. if I were you I would talk to my PCP and see if they can update your files(not falsify or anything) - I'm sure that you actually did talk about your diet when you were going every month, so they just need to document it accurately.

I hope all goes well for you - keep us posted.

[Bethanyblondie 0]

I have Cigna insurance and sounds like our requirements are exactly the same. I just turned in my paperwork to the insurance coordinator today, and I definitely got nervous looking at a few of my weight checks. I would think...did we put in enough detail? Did we say the right things? What happens if I get denied over something little that I somehow overlooked?

We did record my weight, BMI, and discussed my diet program and exercise each time. Sometimes she just wrote down things like, "Complying with Weight Watchers Momentum program, exercising 5xweekx30 minutes, recommend adding weight training. Still having trouble keeping portion sizes down."

I can't imagine what else she would have had to write without writing a book every time. I hope it's enough. I'm sure there is a way to fix the problem if they think it's not enough documentation, maybe turn in your food and exercise logs if they need more proof or something. Sagebrush, please let us know what happens with your situation!