When to make my move?

Alright. So I've got my Aetna insurance.  It will covor WLS. And i either need a 3mo or 6mo diet. I'm currently in week 6 of the St. V's diet program which was supposidly designed specifically around aetna's requirements.

I don't really have a regular PCP.  But my plan doesn't require one. When I had first started talking to the St. V's people they said they could start the approval process early even before i finish the diet.   I'm just wondering is it still too early. But I worry about thanksgiving and xmas delays.  And want to get stuff rolling.  Would it be completely unheard of to hope for a quick approval?

I would love to get the surgery in the week or two before xmas.

It is just daunting at times.

The good news is at least that even though the class has shrunk somewhat from people not showing up/quitting. I have managed to keep eating down and have lost 17 pounds so far. only 183 or so more to go.

Congrats on the 17 lbs.. the more you lose now the better it is for the surgery.. :) I actually started the procedure through my surgeons office. In fact it took me almost 18 months before I was approved. So the sooner you start the faster it will get approved. It really is one of those personal decisions. Hope this helped. Take care God bless you Paula

I have Aetna PPO insurance. They wanted 6 months diet or 3 month prepartory diet and exercise program. When I got those 3 months in they submitted to insurance and I was approved in less than a day. I hope the program you are in knows what they are doing. Maybe they are submitting for approval to see what is required. Way to go on the weight loss so far. I was not required to loose any weight before hand. Good luck.

Aetna also requires a 5 year weight history so hopefully you were seeing some doctor during that time to provide that information (they want to verify that your MO has persisted).

The 5 year requirement is the one that has me worried. Over the past 5 years I have't really gone to many doctors. From either lack of coverage or just not getting regular checkups.

I have been over the required bmi the entire time. Its just  a matter of getting records proving it. For example the last time I went to a normal physical because of some issues.   I couldn't be weighed on the scale. (my 400 pounds vs thier 350 max on scale)

Oh yeah, Thanks everyone for the congratulations :) 

Word of caution about having surgery anywhere near a major holiday:  don't!  Hospitals have a difficult time staying at full-staff during the holidays, because nurses and doctors want time off for the holidays too.  If you can wait until after the first of year, you may want to do so.  One of my sisters is a nurse, as is a good friend of mine; they both agree that if possible it's a good idea to avoid having major surgery around a holiday.   Good luck on your continuing journey! Kellie

It is not unheard of, but you need to have the requirements completed before you submit to insurance. Otherwise they will deny it and then you may have to go into appeals. You really do not want to do that. Do you have a surgeon yet? You can start there as well. The 5 year weight history is going to be a challenge. If they require it you have to have it. This one held me up at one point too. I know it is daunting, but be patient and be sure to get everything done and together before you submit. If you miss something and get denied you will regret it. It is worth taking the time to get all of the requirements completed and all of the paperwork together. It took me 4 years to get this procedure. Trust me, if they can find a reason to deny you they will. Don't give them any room. Congrats on your weight loss so far. ~ Terisa

I have Aetna, and we submitted the request to the insurance company as soon as I completed the 3 month multidisciplinary requirements.  (I was told that it would probably just be wasted effort to submit before then, even if all I needed was the third visit to the surgeon/nutritionist/physiologist.  They lost the first fax, but once we re-sent it (how do you lose a 50+ page fax?!?), I got approval in less than 2 days! Make sure you send EVERYTHING that Aetna asks for, though, because they are notorious for denying surgery because of insufficient documentation.  If something is missing, include a letter from you explaining why the information isn't available. I second the warning about having surgery right around a major holiday.  Not only do the hospitals often have staffing issues, but you will want to be feeling good for the holidays and a couple of weeks probably won;t have you feeling your best yet, even with lapaoscopic surgery. Good luck with your approval! Lora