Depressed

I am ready to give up. I had hoped that I would be approved soon, but I called Aetna today and they have no record of  my paperwork. Jodie at Penrose said she sent it in almost a week and hal*****hat and I should have been a better advocate for myself, but I trusted the clinic to know the in and outs of all the insurances (since they want to get paid) and I found out through this board that I need 5 years of weight history. I don't have that since I did not go to the doctor for years before I got married again and had insurance.....So I have a feeling I will have to wait 3 more years to get this done. I pretty much want to give up. I had hoped to be a mother again after the 2 year wait after surgery.......I don't want to have kids after 40. Waiting for 3 more years kills that idea. I have been miserable for the last 2 weeks....I gave up pop (which was my drink of choice for caffeine - I don't do tea or coffee) - headaches everyday, no energy anymore, and the waiting.....only to find out I was waiting for nothing........ I have been working at getting this procedure for over 1.5 years now and now it seems like it was just a waste of time. For some reason everything has been working against me doing this. The first was the 'lost month' of my supervised diet that set me back 4 months, then it was the 'lost money' when it came to pay for the support visits (with Penrose you have to pay 750 out of pocket for NUT and psych and things - husband spent it even though he knew I had it set aside). Then it was Jodie never got my Psych eval and my phone calls got her to gather everything to send into the insurance (she was sick for a while).....and now they don't have a record of anything there..... I called today as soon as I got off the phone with Aetna but no phone call back from Jodie. I am sure she is very busy - I bet summer is like the 'busy' season. But if that is the case, maybe they should hire someone to help Jodie. I am freaked out here and I cannot even get a phone call to let me know she got the message and will look into it. I just want to go to the store and by a 20oz Mt. Dew drink it and cry.

Don't give up...I know that you have called Jodi already, but call her first thing Monday Morning, and if you get voicemail, make sure you say that it is the second message and you would really like a call so you know what is going on.  I had to do that early on with Jodi, and after that, she always returned my calls the same day (if I left the message early enough). As for your 5 year history, do you have a good enough relationship with your PCP that he/she could write a letter stating the facts about your weight, you already have the info from the supervised diet, so that should help.  I will keep you in my prayers that you get a postive answer soon.  Gayle

I used the same surgical practice and I recall that at the orientation meeting they handed out a form where you list your weightloss attempts.  I filled it out for a many years as I could remember.  Did you get such a form?  I listed everything like Weigh****chers, NutriSystem, self-diet attempts, etc..  This might be enough.  Each insurance company is different, and each Aetna or each Kaiser is different.

And yes, give Jodi another call, schmooze her a bit.

If i was you and was required to have that many years history I would just make it up  they arn't going to check it. 

Here is a report from what I posted in the main board:

So I have been going back and forth with my insurance and clinic. First the clinic said they sent the stuff to insurance about 2 weeks ago. I called insurance at 1.5 weeks to see how things were going and they said they never got anything! So I gather the info the insurance gives (number to fax to, to who's attention, etc) and call back the clinic. After 2 phone calls to clinic, they call back finally and say we fax it again to the info you gave us. So the next day I call insurance again to make sure they got it....they wouldn't really answer if they got it or not, but kept telling me that the clinic should have CALLED first to open a pre-cert claim, let the insurance assign a nurse to the open claim, THEN fax the paperwork requested by the nurse. WTF?!?!?!?!?!? Needless to say I WENT OFF as nicely as I could on how they needed to train ALL of their CSRs to give out the correct frickin information!!!!!!!!!! In the mean time, I am in contact with my husband's work insurance liaison person who is also trying to check up on things for me. I get off the phone with the insurance after our nice chat and I call the clinic back once again and tell them the new requirements. They call me back the next day (today) to tell me that they had sent it again with the newest info. I call the liaison next and tell her what happened. She also called me back today to tell me she verified that they have the records and it can take from 10-14 days to get an answer. Finally! I know they got it and there is an answer coming! Now it is time to work on the appeal that I know it coming because I don't have a 5 year record of my weight. Here is where the fun comes in. I can show from the doc’s office that I was 320 in 2002. That is 5 years ago. I can show also weight for 2005, 2006, and of course 2007. What I don’t have is 2003 and 2004. But if you read the Bulletin posted by my insurance (Aetna) it says

Presence of severe obesity that has persisted for at least 5 years, defined as any of the following:

1. Body mass index (BMI)* exceeding 40; or

2.      BMI* greater than 35 in conjunction with any of the following severe co-morbidities:

Well, my obesity has persisted for at least 5 years since I can show I was MO in 2002 and still am in 2007. UNLESS (and I know these jackasses since they don't want to pay) the insurance will say that I was not MO in 2003 and 2004. *******s. I have a feeling that will be the case. I am even going back as far at 1997 to get records that show my weight has done nothing but increase. I think I was even MO as far back as 1997. I bet this STILL wont help, but I am gonna do it! Arh....thanks for the vent. I am just pretty upset at it all because I have a feeling I will be waiting another 2 years for this to happen.