had intestinal bypass-need appeal help

cindy E.
on 1/20/04 6:25 pm - hudson, FL
Aetna has denied me a gastric bypass because they say I have already had the surgery in the 70's when I had the intestinal bypass. The surgeries are very different. The old surgery was under the belief that you could eat as much as you desired, and the body would not absorb it so the person would loose weight. There was extreme mortality rate, (many say as high as 50%) because of complications and malnutrition. I was one of the "lucky ones". I didn't loose all the weight, what I did loose came back. I am alive and grateful for that. What I need is help in appealing my case. I do not have a clue how to approach this. How do I prove this is not the same surgery just because they both work with the intestines and desire weight loss. I am not a medical person at all! Does anyone out there have experience in this? I qualify for the surgery in all other areas and my insurance does cover wls. Thank you in advance to anyone who can help me.
LornaB
on 1/26/04 11:21 pm - Wayland, MI
Cindy: I just happened to log on to the Florida message board. I'm in the frozen tundra of Michigan and am headed your way on Thursday. Anyway, I had gastric by-pass surgery 25 years ago. Gained it all back plus. Did Optifast 2x, Nutri-system and of course WW and every other diet known to man. 11/24/03 I had my new surgery. 9 weeks out and I'm down 70# from the pre-surg diet. You are right, it is very different. Perhaps you can find a doctor that will help you with your fight. My surgeon has an insurance gal that is top notch at getting things approved. Don't stop at the door if it's closed on you, open another and another and another until you get the answer you need. A friend of mine was declined by her PPO last year. When enrollment opened, she switched to BCBS and now is approved. Keep trying.
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