Kinda Denied...waiting...
Enzo this is just a small set back let your surgeon work his magic with the insurance company and we will see what the out come will be.....hang in there this will happen for you when it is ment to be.....I was denied 3 times before I finally got approved.....everything in it right time....
sending vibes 
your way and hope everything goes well, we saved you a seat on the losers bench........
Christine
your way and hope everything goes well, we saved you a seat on the losers bench........
Christine 
(deactivated member)
on 6/22/05 3:10 am - MT
on 6/22/05 3:10 am - MT
Enzo,
Hun I am so sorry....
I know you must be so upset....~hugs you~ Please just hang in there and maybe the Dr will get through to the Ins Comp. I know Aetna is one of them that require that stupid 6 months weight loss program but maybe the Dr. can appeal it for you......~crossing my fingers~
I will keep you in my prayers and thoughts, please if you know anything just post and let us know.....
Did your Dr tell you about the 6 month weight loss requirement? Why do these Dr's not know this before going into this!!! Sorry Enzo but I hate to see someone all set on surgery and then they get knocked down.
OK I will shut up now.....~hugs you~ If you need to chat just email me hun.....
Debra P 
I know you must be so upset....~hugs you~ Please just hang in there and maybe the Dr will get through to the Ins Comp. I know Aetna is one of them that require that stupid 6 months weight loss program but maybe the Dr. can appeal it for you......~crossing my fingers~
I will keep you in my prayers and thoughts, please if you know anything just post and let us know.....
Did your Dr tell you about the 6 month weight loss requirement? Why do these Dr's not know this before going into this!!! Sorry Enzo but I hate to see someone all set on surgery and then they get knocked down.
OK I will shut up now.....~hugs you~ If you need to chat just email me hun.....
Debra P No more Kinda...
I am DENIED!!!!
SO SURGERY FOR TOMMOROW CANCELED!!!
I will be going to the nutritionist for a fully monitored weigh loss program and appealing in september.
whatever-
I am very dissapointed.
So now what happens???
If I lose weight on the supervised weight losss program are they going to deny me cause I lost weight?
THIS SUX!
-Enzo
Hi Enzo -
I am sorry to hear about this denial with Aetna - I have the same insurance (QPOS).I'm meeting with my surgeon tomorrow for the 2nd consult, & have had all the tests. I have already done the 6 month weigh in with my PCP- it was the first thing my surgeon told me- however I am still thinking Aetna will deny the surgery.
They originally showed their policy online back in 10.04 and they updated it in 4/05. According to what it says- it says the ins coverage governs the surgery- unless it is medically necessary( which seems to be open for interpretation) and you have to meet all these requirements..and lists them and it used to be -26weeks of phy.supervised dieting - within 2yrs of surgery & I believe they changed it to within the last 52 weeks - so that maybe why your WW didnt count? It had to be from 6/04 to 6/05 . Also at one point they even told me- that unless my employer had a specific rider to INCLUDE this surgery, I had no coverage. I then had my employer ( its a small company) call their Aetna liaison,& ask if the rider WAS necessary- she was told No - but I had to conform to their "protocol". This was this past February- and I was 3 mos into supervision/PCP.
I have been looking to see what other patients had Aetna and were approved (here).My PCP, who is also shares Dr Garber's (my surgeon) office suite, told me in May, that surgeries were being approved, even by Aetna,(within 2 weeks), as long as they contained the 26 week WL supervision. He said (ins companies) hope you lose so much they don't have to pay for the surgery.
I am not happy about their policy either - but you may also want to take a look at a lawyer that specializes in suing ins. companies over policy - to help you in the appeal - and also see how much of this "protocol" you conform to, to have grounds for the reversal. Aetna very clearly stipulates - that just because surgery is medically necessary, they don't have to approve it for payment. This is where the NIH and NYS dept of insurance come in. If it can be proven they are violating NYS regs or discriminating against one group of people, you can very well win a legal claim against them. Of course, I am not saying it can go that far - but this is where I am at with Aetna- and I expect the worst- but won't know until Dr Garber submits the claim.
On a similar note- I have a friend who was denied by United for the lap band- and denied categorically 2 times. She won on appeal and is having her surgery on July 6.
Let me know how it goes for you.
Donna 
I am sorry to hear about this denial with Aetna - I have the same insurance (QPOS).I'm meeting with my surgeon tomorrow for the 2nd consult, & have had all the tests. I have already done the 6 month weigh in with my PCP- it was the first thing my surgeon told me- however I am still thinking Aetna will deny the surgery.
They originally showed their policy online back in 10.04 and they updated it in 4/05. According to what it says- it says the ins coverage governs the surgery- unless it is medically necessary( which seems to be open for interpretation) and you have to meet all these requirements..and lists them and it used to be -26weeks of phy.supervised dieting - within 2yrs of surgery & I believe they changed it to within the last 52 weeks - so that maybe why your WW didnt count? It had to be from 6/04 to 6/05 . Also at one point they even told me- that unless my employer had a specific rider to INCLUDE this surgery, I had no coverage. I then had my employer ( its a small company) call their Aetna liaison,& ask if the rider WAS necessary- she was told No - but I had to conform to their "protocol". This was this past February- and I was 3 mos into supervision/PCP.
I have been looking to see what other patients had Aetna and were approved (here).My PCP, who is also shares Dr Garber's (my surgeon) office suite, told me in May, that surgeries were being approved, even by Aetna,(within 2 weeks), as long as they contained the 26 week WL supervision. He said (ins companies) hope you lose so much they don't have to pay for the surgery.
I am not happy about their policy either - but you may also want to take a look at a lawyer that specializes in suing ins. companies over policy - to help you in the appeal - and also see how much of this "protocol" you conform to, to have grounds for the reversal. Aetna very clearly stipulates - that just because surgery is medically necessary, they don't have to approve it for payment. This is where the NIH and NYS dept of insurance come in. If it can be proven they are violating NYS regs or discriminating against one group of people, you can very well win a legal claim against them. Of course, I am not saying it can go that far - but this is where I am at with Aetna- and I expect the worst- but won't know until Dr Garber submits the claim.
On a similar note- I have a friend who was denied by United for the lap band- and denied categorically 2 times. She won on appeal and is having her surgery on July 6.
Let me know how it goes for you.
Donna So sorry to hear that.........I'm n the same boat, except Oxford approve me monday.........3 different people approved it and today some paper pusher calls to tell me that they are taking back my approval, because of some insurance technicality.........related to pre existing and conditions and previous coverage............I'm so sad !!!!!!!!! angry, dissapointed.....so I know how u feel.......good luck to u..........Maria
(deactivated member)
on 6/24/05 4:54 am - MT
on 6/24/05 4:54 am - MT
Enzo,
Hun please know that when you do this weight loss thing you so not really have to follow it, well I didn't to the letter and I only lost 10 lbs in 6 months. I don't know wha the answer is with that but I do know that you eat like you are and do not lose to much weight just in case. 
I hate these Ins Comps, waisting Dr's and our time, never less our co pays to see these Dr's once a month for 6 months. *shaking head*
Enzo, please so not give up and hang in there, I know you are upset, I have been there myself and it really does suck but know that it will happen for you and take this time to read and learn more....~hugs~
Please email me and let me know you are doing ok?
Take care
Debra P
I hate these Ins Comps, waisting Dr's and our time, never less our co pays to see these Dr's once a month for 6 months. *shaking head*
Enzo, please so not give up and hang in there, I know you are upset, I have been there myself and it really does suck but know that it will happen for you and take this time to read and learn more....~hugs~
Please email me and let me know you are doing ok?
Take care
Debra P Ya i am going crazy over here. my surgery is scheduled for july 8 and its still pending. but I dont think my doctor documented well and i think that will reseult in my denial. screw the facts ive been obese for 24 yeras of my life , i have gallstones, hernia, acid reflux severe back pain. what do they care. I am hoping to give atena a good name. im waiting!
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