Major bump in the road!

Yes I've already thought about this... my open enrollment isnt until august but that may be my only option... My other insurance choice would be Kaiser. Thank you for your suggestion :)

As cannot see the paperwork you were sent, I have a question.  Are they asking you to meet all of the criteria, or are they asking you to check off which problems you have.  You may only have to have three or more.    Does it actually say you have to have all of the requirements on the paperwork?  If you want to e-mail me, feel free to do so. Sharon

Hi Sharon.. Thanks for your help :) I will attempt to attach the form here. If you dont mind take a look and let me know what you think... The  way I read it I can only go for Category 2 with two co-morbids... problem is, I only have one on that list...I could possibly go for C. = BMI over 50 (which I am now 54) but the form says that you have to have these co-morbid for at least 5 years... there was about a year within that time that I was under 50 BMI.. Im also thinking maybe I should have my doctor send me in for a sleep study... maybe I have sleep apnea and dont realize it...   what do you think ?? But then do I have to prove that ive had it for 5 years..?? Oh gheez... I am beside myself    well I can't figure out how to attach form... if you dont mind will you send me an email so I can reply that way.... [email protected] Thanks again

Kellie,    I had to jump through many of the insurance companies hoops.  I initially jumped through all of Aetna's hoops and began jumping through Kaiser's.  I got so frustrated I hired Obesitylaw.com to get me through.  I am now a little shy of 10 months post op and have lost 115 lbs.  Please feel free to private message me if you want any more details. Best of luck to you!!! Hugs, Heather

Kellie,

I can only tell you about my experience with Kaiser. I have been a Kaiser patient my entire life. I was born at Kaiser Walnut Creek and have stuck with Kaiser for one main reason. I do not have to jump through alot of hoops to get what I want to get.  If my PCP says I need it and Kaiser covers it, I get it!

 I started my WLS journey on 7/20/07. I was approved the first time and am supposed to be having surgery sometime before April. (If I decide to have RNY WLS - My mind is still not made up.)

The best part of my story is that my PCP, Dr. Orna Hananel, was the person who asked me if I wanted WLS. I said sure and then she reffered me.  I have only had one problem so far. My chart got lost after my Psych eval. I waited 4 months for a call back and never got one. So, I called them. They had not called me back because they were not aware I existed as part of the Bariatric Program. : )

So, I would deffinatley check into Kaiser. I do not know where you live but I live in Novato, CA. The Bay Area. There are several Kaisers up here who do this surgery. I am haiving mine at Kaiser Richmond. My PCP is in the San Rafael office. Most PCP doctors at Kaiser will have no problem speaking with your old Aetna PCP Doctor. This way, they learn a little info about your history and can actually ask your old PCP if WLS was something that he/she thought would benefit you!

If you can contact the HR manager of your work and ask them to verify what the covereage is they have for Kaiser on their plan, I would. The HR manager may have you contact their broker to get the info you want.  The reason I suggest doing this is because it would suck if you switched and then found out that the Kaiser covereage you have does not include WLS as a covered benefit.

GOOD LUCK! Just keep with it and don't give up! If you need help doing some reearch about Kaiser let me know. I would love to be able to help out as much as I can.

Sara

Novato, CA

Did I ever tell anyone that I HATE AETNA.  Many complain about Kaiser, they educate you. Education is pivotal  to success.  But, AETNA  SUCKS!! I hate trying to get auth out of them. They require documentation of 5 years of obestiy and then they require 6 months of consecutive monitored wt loss in the previous 2 years.   The other ??? to ask is your medical group a full risk or partial risk group. If they are a partial risk the insurance gets involved. If it is full risk the medical group is responsible for the auth entirely. You could go thru the process and take it to all levels of appeals and then get a wt loss attorney such as obesity law. Best of wishes. Aetna is the dragon to slay. Liz