Denied...then approved...don't lose hope

brad0000
on 7/30/14 9:43 am

Just wanted to share my story in case it might help someone else ease their own anxieties.

I started the process for WLS around February of this year, and I was done with the medically supervised weight loss required by my insurance in May. When all of my information was sent to insurance, I was initially denied with Aetna saying that WLS was not a covered benefit under my plan. I was really upset by this. I have worked extra hard since February and lost 40 pounds on my own via exercise and better nutrition, but I've been stalled there for about two months now (I swear by myfitnesspal). As a side note, it is not unusual for me to lose weight in the summer when I'm not studying or teaching, but then I seem to gain it all back once the new school year starts. I wonder how many other teachers and academics suffer this same problem. I am into an excellent exercise and nutrition regimen now and I'm hoping WLS is the missing piece to help me finally break this cycle.

When i called the insurance coordinator at the surgery program he was as perplexed as me because they had already verified my coverage for the specific procedure and they were told it was indeed covered. I am a Ph.D. student and have student health insurance, and it's really not the best. According to my plan information from the school the surgery was not excluded so I contacted my school's in-house plan administrator and asked her to look into it with Aetna.

The next I heard was that Aetna was reviewing but that now the weight history that was submitted was inadequate. The reason for this is that the scale in the university's health services just didn't go high enough to record my weight, and so the weight information was incomplete in my charts. I had to gather a letter from my doctor attesting to this and wait several more weeks to hear anything more. Finally today I received the call that my surgery is approved and scheduled for October.

I have been lurking here and reading many of your stories for several months now but I hesitated to join in the conversation because I was unsure if I would be approved for surgery. I have really learned from your stories and believe I am positioned for success after my surgery in October because of them. For those of you who have been denied, I feel your pain. Keep your chin up and work with your surgeon's office on the appeal, they are there to help you. I hope it works out for you too.

Brad