Upset - Numb

Well, some of you may have heard my story, but I will tell it again. I received a letter from Aetna stating that I was approved for the surgery and had six months from the date of the letter to get the surgery. I had the surgery scheduled on Oct. 5, 2004 and my surgeon left the Aetna network. I called Aetna and explained the situation to them and they said, I needed to find another surgeon in the Aetna network. Since, I had been to Dr. Duncan seminar in March and he was my second choice for surgeons I decided that I would go with him. I took my paper work into his office around the 8th October and start calling his office a week after I dropped off the paper work to get an appt. After several calls and voice mails being left I finally got an appt. date on Nov.16, 2004. At this visit there were several other ladies, we complete a quiz, got weighed and was given all the pre-op test that we needed to complete before getting a surgery date. Also, we were told if we got our test done quickly we could get a date before Jan. 1, 2005. This was for those of us that had time constraints. I completed all my pre-op requirments on Dec. 9, 2004 and began calling the doctor office to let them know so I could get in for a surgery date. Well, I never got a return call after several attempts to tell my story to anyone that would listen at Dr. Duncan's office. After, the first of the year I posted a message asking for help on how to get someone to call me back from the Dr.s office or someone else I could speak with beside Yakima. I got several great suggestions and to my surprise I finally got through to Jennifer. I explained my situation to her all about my Nov. 16 appt., told her that I was already approved and a copy of the approval was delivered to them in Oct., that all my pre-ops were completed and all that was requested for me to do was done so I could get an appt. with the surgeon to get a surgery date. Jennifer said, she would call me back after she looks over my file. She went on vacation for a week and I did not hear from her. I did speak with Yakima and she told me that my pre-op result had not been recieved. I called my PCP to have them faxed over again. I call back on a Monday and Jennifer was back and she told me that she was going to call for authorize number and call me back at work that was last Monday. Today makes 9 business days later, so I call today and Jennifer said, she still had not recieved the authorization number. I told her I would call Aetna to see if I could get them to fax something over today. GUESS WHAT.....THEY TOLD ME THAT MY PLAN IS NOT COVERING THE SURGERY IN 2005!!! I am soooooo upset!! I called my benefits dept. at work and they said, they are no longer covering the surgery. I replied during open enrollment we were told if we wanted the same coverage as last year we did not need to fill out any new forms, because I coverage is not changing. They lied it did change they decided not to cover WLS. I called Aetna and they said, it is up to my employer and my employer is saying it is up to Aetna. I can just SCREAM. I do not know what to do from here. Sorry, this was so long....any suggestions? I called my benefit rep and told her that I need to talk to someone over her and she said, she would get back to me. Help anyone, please!!

I wish I knew some magic words to make it all the way it needs to be, but unfortunately I don't. Just don't give up. We will all get it figured out some day so everyone who needs this surgery can have it. If you need anything, just yell and I will be glad to do what I can to help. Hugs, Debra =^..^=

I feel your pain gf......I was 3 days away from surgery when I got the call from Dr. Burrowes office saying that my surgery had been cancelled because BCBS wasn't going to pay for it. My plan renewed on january 5th and my surgery was scheduled for Jan 10th. I cried for days and walked around in disbelief. The only thing you can do really for the immediate is to convince your employer to call Aetna and add on the rider. If you need to talk PLEASE e-mail me. LOL...I need to start a get together with the people who have been rejected...we could call it WANNA BE LOSERS!! *sigh* Shree

I am sooooo sorry about your situation. I would keep calling! I would also call the insurance commissioner. It really seems unfair!!!! Big ((((((((((((((HUGS)))))))))))))) to you!!!! Love, Becky