Recent Posts
Topic: RE: Aetna Difficulty
Hi, I'm not sure what surgery you are looking into. I too have Aetna and am in the process of getting approved for the VSG. I am hopeful as I have a high BMI, a lot of co-morbities. I have heard that Aetna does approve VSG's for those reasons.
On the VSG forum there is a woman (I think it was Sleeve Jeanie) who has a appeal letter on her profile. It has been used by several people (it's generic and you or your doctor put in the specific information for you), and those people have been successful. I would post the question there if you are hoping to have the VSG, or really they are very nice on that forum and will answer you no matter what kind of surgery you are hoping to have. I hope this helps you.
From what I understand if you can document and keep persisting, it is possible to get your denial reversed. The squeaky wheel gets the grease. A lot will depend on your BMI, and what co-morbidities you have. If you are being denied due to the type of surgery you are requesting, you can often change your request, get that approved and then find a technicality which makes it necessary to change to the type of surgery you want. Example.....if you want the VSG but are denied due to it's considered 'experimental', then get approved for the RNY instead, then if you have reason to take NSAIDs for pain/arthritis/etc (NSAID's are not allowed post-op with the RNY) you can appeal on that ground to get them to approve the VSG. I hope that isn't too confusing of an explanation.
Best wishes in this journey.
On the VSG forum there is a woman (I think it was Sleeve Jeanie) who has a appeal letter on her profile. It has been used by several people (it's generic and you or your doctor put in the specific information for you), and those people have been successful. I would post the question there if you are hoping to have the VSG, or really they are very nice on that forum and will answer you no matter what kind of surgery you are hoping to have. I hope this helps you.
From what I understand if you can document and keep persisting, it is possible to get your denial reversed. The squeaky wheel gets the grease. A lot will depend on your BMI, and what co-morbidities you have. If you are being denied due to the type of surgery you are requesting, you can often change your request, get that approved and then find a technicality which makes it necessary to change to the type of surgery you want. Example.....if you want the VSG but are denied due to it's considered 'experimental', then get approved for the RNY instead, then if you have reason to take NSAIDs for pain/arthritis/etc (NSAID's are not allowed post-op with the RNY) you can appeal on that ground to get them to approve the VSG. I hope that isn't too confusing of an explanation.
Best wishes in this journey.
Topic: RE: how do you move to another company?
You should be able to call and ask for copies of all your medical records. Best of luck to you!!
Topic: RE: Confused
Not sure what that means? food dream killer?
But I sure hope you are doing well!
But I sure hope you are doing well!
Topic: RE: Bariatric Seminar in Sheboygan!
I have heard good things about Dr. Chua. A couple of my friends have gone to him for their surgeries and have been happy with the results.
I really hope things go well for you!
I really hope things go well for you!
Avoid kemmerling, Green Bay, WI
omar88
on 8/12/10 12:16 am
on 8/12/10 12:16 am
Topic: how do you move to another company?
Hi, how do you request a copy of the documents from the Bariatric Institute and move to another company? I consulted 2 other companies and they stated I could enroll in their program and they have been more successful with dealing with aetna than The Insitute. Has anyone done this?
omar88
on 8/12/10 12:14 am
on 8/12/10 12:14 am
Topic: Aetna Difficulty
hi, i was denied, and how does the appeal process work, and can you represent yourself?
also, can a person get all their documents from Bariatric Institute and move to another company?
also, can a person get all their documents from Bariatric Institute and move to another company?
Topic: RE: Confused
I love Mary, but she is a food dream killer, and my friend's mom is a dietian also and its just easier getting my advice from her.
Topic: RE: Confused
Well, you are 5 days post op now, I hope you are feeling well. I would meet with Mary, the dietician at Elmbrook, she is amazing. I had a different surgery than you, so my guidelines are different, but I think Elmbrook should have given you big packets of handouts.
I hope you are feeling well and I hope to see you at support group meetings in the future!
I hope you are feeling well and I hope to see you at support group meetings in the future!
jwj
on 8/9/10 8:06 am - Oshkosh, WI
on 8/9/10 8:06 am - Oshkosh, WI
Topic: RE: Bariatric Seminar in Sheboygan!
I think it says a lot about a surgeon's character when he has patients come and speak as part of the informational seminar. I once had a surgeon fly me to Utah to talk at his seminar. I did that about 4 or 5 times and he has since videotaped it. The last time I spoke with him he said the videotape is not as good as having me there, however he understands that time constraints would make it impossible for me to be at each one. He obviously is very confident in his expertise as he is a firm believer in the fact that it is one thing to be told there are risks, but as he puts it "it is another thing to actually be able to see and hear and feel risk". He said he had never read medical records like mine before and simply couldn't resist the possibility of having me speak. My speech was not to discourage people from having surgery, it was about the risks associated with surgery, it was about the fact that you have to listen to your body even if your surgeon is making you feel like you are some borderline psychiatric case. Hats off to the surgeons who have enough confidence in themselves to tell the BAD with the good! I'd pick one of them before I'd ever pick a "Kevin Wasco" again. Incidentally, I did not "pick" Kevin Wasco. I was assigned to him without choice. I wonder when he'll be man enough to have me tell of my experience at one of his seminars?
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