Countdown Question

What was your experience with the surgery approval with the insurance? I personally had no problem. The one funny thing was that I postponed my surgery from June 2004 to August 2004. I was going to graduate from school 2 days after the surgery. The graduation was going to be in a small football stadium. I had to walk down to the grass field from the bleachers. I ended up rescheduling the surgery. When July came around my aproval had expired. I forgot to tell my doctor to ask for a new aproval for the surgery. It was no problem. The funny part would be to arrive for the surgery and be told that my insurance had not aproved it.

my approval was tough. blue care network is one of the hardest to be approved. They deny everyone, then most who persue it further get it approved in an in person appeal....well you have to have i think it was three denials first. well i had no diet attempts in my chart so that was the reason for denial. well at the in person appeal i told them it was not my fault my pcp didn't document it (actually i was fibbing, i gave up on diets long ago) and they sent a letter to me five days later saying i was approved.....i am actually very glad it took so long, it gave me a chance to find the oh message board and learn so much and make such great friends. did you graduate from high school or college? Sorry, i'm having a blonde moment. hugs Linda

Linda, I graduated from Elementary school. I wish. After I lost my job of 15 years I decided to go back to school and get an education. I just like you had worked in the circuit board field. I went to a junior college and got my degree as a Library Technitian. I am a Librarian now. I think we all gave up on the diets. Thanks for the idea. I will continue posting messages this month. You can give me a helping hand and post a question or message. Talk to you later and take care.

Great question, Louis. I decided in August, 2003 that this surgery was the route I wanted to take, and I found out that my insurance, Aetna HMO, did cover it but I had to do the required 6-month supervised diet deal. I researched and tried to find a good surgeon, and then in December, 2003 started my 6-month plan. Wouldn't you know, in February 2004, Aetna changed their rules where you only have to do a 3-month plan?! However, I was grandfathered in under the other plan, so I had to do the six months. The Aetna information stated that I could submit for approval after three months, with the understanding that I had to complete all six months prior to having the surgery. In April, I chose my wonderful surgeon, Dr. James Davidson in Dallas, and his office submitted for approval. I was denied, with Aetna saying that I hadn't completed all six months. Well duh! I knew that, but I had also been told that I could pre-submit. I was disappointed but not defeated. We resubmitted in early July upon completion of the whole six months, and the waiting game began. I left town early in the morning of Tuesday, July 27 because my dearest friend who lived out of town was having a baby. I was gone from work Tuesday and Wednesday and made a point not to check my work messages, because I didn't want to deal with work during such a neat time. When I got home late on July 28, there was a letter from Aetna in the mail, and I nervously opened it. I had been approved! I was beside myself, completely. I couldn't get over it. I had wanted this for nearly a year and the reality was finally here! What's funny is that when I got to work the next day, there was a message on my voice mail from the surgeon's office, saying that I had been approved. That call had come on Tuesday, so I would have known the whole time I was out of town, had I checked messages. However, opening the envelope was like nothing else, so I'm glad I didn't know! They were able to schedule my surgery for August 12, just two weeks after I learned that I was approved. Those two weeks were like an extended Christmas Eve. I was so fortunate and excited! I'm very lucky that I was approved in 2004, because Aetna no longer covers the surgery unless the employer buys separate coverage for it, and it's too expensive for most employers to add on. I really feel like I was supposed to have the surgery when I did. So blessed! Sorry so long, but that's my story. Thanks for the fun idea, Louis! Everyone have a great weekend. Kathryn

Kathryn, your story is funny. A six month dieit? I understand the reason why the surgeion want us to lose weight, but you want the surgery because you can't lose the weight. Is it better for the insurance to aprove the surgery than to be paying for medication and treatments for an overweight person who is sick? Yes, you were blessed. I am happy you liked the question. I hope you have a question or comment for us. You too have a great weekend and take care.

I was excited! My surgeons office had submitted to my medical group around 6/27 or so and they needed approval from the actual health plan so they faxed everything for approval on 7/2...on 7/8 I called to see if they had received everything and was told I had an approval! It was so easy! Kristy EDD 8/6/06 36 weeks It's a girl - Alice Kay

Kristy, that was great that you had a smooth process to get aporved. Can't waite to see pictures of your new baby. Incase I haven't said it CONGRATULATIONS. Take care of yourself and your new baby

Congrats on your pregnancy. I have a 6 month old daughter! Hope it's been smooth! Angelina 5'4" 253/149/135-140 someday