afriad of denial

I have Aetna and i am afraid of being denied. allthe work i put into trying to get all my paperwork done and seeing all these doctors and finding out i had alot more worng with me then i knew. I dont know how well my doctors doscuments are. He didnt seem to concerned. Now aetna of course says it takes 7-10 days to review. today is day 5 and i cant take it! im going crazy. even if im denied ill appeal and get a lawyer and stuff. ugh this anticipation is making me really stressed. please say prayers for me. I really need this surgery to improve my life. I dont want the pains and aches and sickness ifeel from being overweight help!

Kristy, I wish you the best hun and I hope you hear something very soon, good news..... I know that Aetna is one that requires that 6 month weight loss program with a Dr, did you have that done already? If so then I bet it should go through just fine. Starting to hate these Ins Comp!!! They want the money but will not pay..... I will keep you in my thoughts and prayers hun...~hugs~ Debra P

Kristy Hi! As long as you have met their criteria, you will be approved quickly. I will be praying that you get your approval soon. Concentrate on why you have made this decision and getting ready for your "DAY" to keep your mind off of receiving "the letter". I know, easier said than done. Whatever happens, God has His reasons. But do not let anyone or anything stop you from reaching your ultimate goal. I also have Aetna, but they denied me after I had been approved by BC/BS as I did not meet the Aetna criteria, which is 6 months of supervised program. I have now met their criteria and received a letter from them that they have forwarded the "packet" to the Ingersoll-Rand Medical Review Board as Ingersoll-Rand is "self-funded". Therefore, IR has the final determination. I am still waiting and the info was sent to IR on 6/9, which they actually received on 6/15. I am hoping for an answer today!!!! (I have been in contact with the IR Medical Review Board office.) Have a wonderful day!! Enjoy the fantastic weather!!! Let us know as soon as you receive your approval. Keeping you in my thoughts and prayers. {{{{HUGS}}}} Brenda

kristy- i have aetna ppo, and it took one day for them to approve me. my doctor orginally submitted my paper work, but i was denied due to not having 6 months of supervised dieting documented. turns out i had been to two diet doctors in the previous 2 years which total out to just 6 months. they faxed the info to my doctor, my doctor's office sent it to aetna and i was approved within hours. just make sure everything is in order, and you won't have any problems. donna open rny mar 18 2003 282/140/135

Kristy, I just got denied by aetna 1 day pre-op. I have there exact wording here: i: nutrtion and exercise program must be supervise and monitored by a physician working in cooperation with dieticians and/or nutritionists; and ii: nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration, with participation in one program of at least three consecutive months, prior to the date of the surgery. (precertification may be made prior to the completion of nutrition and exercise program as long as a sumulative of six months participation in nutrition and exercise program(s)will be completed prior to the date of surgery.);and iii: nutrition and exercise program must occur within two years prior to surgery; and iv:Member's participation in physician supervised nutrition and exercise program must be documented in the medical record by an attending physicianwho supervised the members participation. The nutrition and exercise program may be administered as part of the surgical preparitive regimen,and participation in the nutrition and exercise program may be supervised by the surgeon who will preform the surgery or by some other physician. NOTE: A physician's summary letter is not sufficent documentation. Documentation should include medical records of physician's contemporaneous assessment of patients progress throughout the course of the nutrition and exercise program. That's pretty much it about the physicians notes as to the nutrition and exercise program. It's amazing to me that they get away with s**t like that but they do. My best advice is not to be afraid, just be prepared for the worst case scenario. What I mean by be prepared: enroll now into a physician assisted weightloss program, if you are worried that whot you have will not count. Speak to your surgeon about a program he may have in conjunction with a nutritionist. GOOD LUCK, I hope this info helped... ENZO-

this is interesting what enzo has added. i orginally wanted a lapband but aetna denied me. i spoke to a rep. from aetna and i was told that there was a possiblilty that aetna was going to make it harder in the future to have wls. pretty much she told me if i could get approved for a rny i should just go ahead and do it. i'm surprised it is so involved now. when i had surgery 2.5 years ago you just needed to have a bmi of 40+, a letter from your pcp saying you needed wls, and proof that you dieted for 6 months with in the past 2 years. i had went to 2 diet doctors who sent my records to my wl surgeon, who then forward them to aetna. technically i was denied twice, but when all the proper info was sent to aetna they approved me within hours. donna