No decision by Aetna, RNY for 7/27 cancelled...

michellemc0
on 7/25/09 4:46 am - bridgewater, MA
...which I'm not surprised about, but I'm really irritated because if the paperwork had been submitted when it should have been (7/2) as opposed to when it finally was (7/20, after I called twice) I'd at least have an answer, and would possibly be having the surgery Monday.

This is the worst part:  I've had to 'hand-hold' my hospital AND my insurance to get anything done.  When I finally got the 'no go' from my surgeon's office, the girl I talked to said "Oh, Aetna says they need you to have been on a 3-month PHYSICIAN-supervised diet, not a 3-month NUTRIOTIONIST-supervised diet."  I said "I've seen Dr. S. FOUR times in the last three months.  SHE'S supervising it!"

I mean, shouldn't they know this???  I followed Aetna's requirements to the letter.  Why is my hospital's insurance person ignorant to the fact that I DID see the physician 4 times?  Why is this not clear in the paperwork the hospital sent to the insurance co.?  

I'm quickly losing faith that this will happen at all w/out an appeal.  I'm just depressed and a little angry at this point.  Everything I did should be crystal clear to my insurance co. and the fact that they can't see that the FIRST thing they should be able to see--4 physicians appts--makes me wonder what else is missing.

Sorry, I'm just extremely disappointed that my surgery was postponed and that I've had to do the legwork between the insurance co and my surgeon's office.  Nothing was done until I called, and then papers would miraculously appear at the insurance co.  It's so aggravating and stressful.
Michelle  ~~~  241/233.6/118.6/125 Starting/Surgery/Current/Goal    
   a few pounds below goal right now!
 

                      
cherrylynrn
on 7/25/09 2:17 pm
I am really sorry to hear this...I can't imagine having had surgery canceled that close to the date...it's so hard to get yourself ready (mentally and physically) and then to have it canceled at the last minute must feel awful...

Don't give up! Keep moving forward and good luck!

    
RazzyRobyn
on 7/25/09 9:31 pm - West Boylston, MA
I'm so sorry for you! I can't magine having surgery getting cancelled so close to your date!!

Please keep us posted o your progress. I will be thinking of you!
Robyn

Highest known weight 268 lbs.
Lowest weight since surgery 115 lbs.
Currently maintaining at 125 lbs.

My RNY has saved my life and given me a new life!

        
dragonfly777
on 7/25/09 11:05 pm
That totally bites, I am so sorry to hear that. Don't get discouraged, it will happen!!



  
tauntonredsox33
on 7/27/09 12:06 am - Taunton, MA
Michelle I PM'd  you earlier...  I can't believe that happened to you..
If I get cancelled to it will be such a let down....    Actually I'm going to call and find out who I need to contact about an offical complaint becuase now I'm irritated too!!!!  We do everything we are suposed to the Dr's office drops the ball it is not right....
Melissa M. 
HW 250/SW 217/CW 117/ 1st GW 133/ 2nd GW 117
        Reached my goal!!!!!!  
Brian1977
on 8/1/09 1:08 pm
Hi michelle!  I'm sorry to hear about AETNA, but I have had similar experiences with insurance companies is the past.  It may not have been the hospital/dr's fault that AETNA didnt recieve the paperwork.  They may have submitted it and AETNA just put it aside and dragged their feet on it.  Insurance companies are famous for doing that.  I know this firsthand b/c i use to work for a health insurance company.  I had a similar thing happen while trying to get my RNY approved.  United Healthcare said that they didnt have the paperwork so I called the doctor and had them resubmit.  Low and behold I called UHC again 2 days later to make sure it was recieved the second time and miraculously they told me they recieved it like 3 weeks earlier.  Go figure.  It just took a little pressure and me *****ing someone out at the insurance company for them to finally get their heads outta their butts and get a move on things. 

As for AETNA, I dont have much nice to say about them, so i will keep it to myself.  I wish you the best of luck in getting approved and I am sure AETNA will do the right thing, just may take a little pushing on your end.  Dont be afraid to ask for a supervisor if you need to!
michellemc0
on 8/1/09 7:43 pm - bridgewater, MA
Thanks Brian.  I am going to cal call them every day, twice a day if necessary, until I get an answer. My new surgery date is 8/11, and again--no decision yet.  I have the number of the assistant to the nurse who is actually handling my case so I need to really start advocating for myself and  calling her until she makes a decision.
Michelle  ~~~  241/233.6/118.6/125 Starting/Surgery/Current/Goal    
   a few pounds below goal right now!
 

                      
Brian1977
on 8/2/09 1:03 am
Absolutely Michelle.  Definitely take the initiative.  whaty i did was call every other day and only requested a supervisor b/c the lady i spoke with firs twas just downright nasty and rude to me.  But definitely follow up at least every other day.  i woulndt recommend twice a day just b/c if you make a pain in the butt out of yourself, they will hesitate some more.  I am sure they will do the right thing, just makes ure you stay on them,  AETNA is a difficult company to deal with from my past experiences, but if you can get someone willing to help, thats the best thing.  I know when i had a problem with them, i ended up escalating all of my claims and issues thru the actual advocate from AETNA that was assigned to deal with my companies higher ups and decision makers.  Once I got her on my side everything went smooth.  Just hang in there.  it will all work out for you.  and again, good luck with everything!!
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