MY QUEST

MY PCP IS WORKING WITH ME TO GET THE BALL ROLLING! AT THE DIRECTION OF MY PCP I WILL BE ATTENDING A GROUP CONSULTATION WITH THE SURGEONS IN 2 WEEKS. SHE SAYS THAT IF AFTER THAT CONSULT I AM STILL DETERMINED TO DO THIS, SHE WILL GIVE ME A REFERRAL. I HAVE ALREADY JOINED THEIR ON-LINE SUPPORT GROUP. I CONTACTED AETNA HMO YESTERDAY AND WAS ADVISED THAT THE WLS IS COVERED UNDER MY PLAN. I AM GOING TO DO EVERYTHING IN MY POWER TO HAVE MY SURGERY BEFORE THE END OF THE YEAR, JUST IN CASE THIS BECOMES AN EXCLUSION NEXT YEAR. PLEASE KEEP GOOD THOUGHTS FOR ME! I WANT THIS SO BADLY!!! I AM TOTALLY MISERABLE. I AM 5'4" AND AM PRESENTLY AT 292.2 LBS WITH A BMI OF 50+.

Hi Linda. I am with Aetna too but they are not including it in our plan as of 3/1/05 which is our renewal so I had to really step things up. I did get approved after having to do an appeal and my surgery is Monday. Just know that you have to do exactly what Aetna requires step by step or they will not approve you. I don't want to scare you off but just be sure to go to Aetna. com and look up their bulletin #157 which will tell you what they require. I would take a copy of this to your PCP so they know exactly what needs to be done. If you follow this and make sure when your PCP sends Aetna a letter that they put the words "medically necessary". If you ever need any help with anything feel free to email me because I have just been thru this so I will be glad to help. Best of luck to you! ~Bonnie

Bonnie, Thank you very much for the information regarding the AETNA bulletin. I will print it out immediately and take it with me on my next appt with my pcp. My insurance just renewed on 1-1-05. My goal for 2005 is to get the wls done. I am going to pu**** as quickly as I can. Perhaps we can be a mini support group for one another. I would like to keep in touch with you to see how you are doing. If you would like to correspond you can reach me at [email protected]. Linda

Hi Linda. I am with Aetna too but they are not including it in our plan as of 3/1/05 which is our renewal so I had to really step things up. I did get approved after having to do an appeal and my surgery is Monday. Just know that you have to do exactly what Aetna requires step by step or they will not approve you. I don't want to scare you off but just be sure to go to Aetna. com and look up their bulletin #157 which will tell you what they require. I would take a copy of this to your PCP so they know exactly what needs to be done. If you follow this and make sure when your PCP sends Aetna a letter that they put the words "medically necessary". If you ever need any help with anything feel free to email me because I have just been thru this so I will be glad to help. Best of luck to you! ~Bonnie