Surgery tomorrow denied today

wildgardener
on 10/16/06 5:47 am - Knoxville, MD
Hi, I cant believe Aetna told me that my policy covered baritatric surgery in July (I have the persons name, date and time), had me go through all the dr. s visits and preoperative testing, then decided that the computer was wrong and the documents exclude the surgery.  I keep calling them and trying to speak to a supervisor, and have gotton sent to voice mail, hung up on, and told to have the doctors office call precert again.  I tried to have the surgery last year, and was told I had to do the 6 month diet - not that the surgery was excluded.  I have 4 children at home, and scheduling surgery around my husbands travel was extremely difficult, plus an hour and 15 minutes each way to the hospital.  UGH!!!!!!!!!!!!!!!!!!!!I called Gary since I had hired him last year, and he is out of town this week.  Any ideas on what I should do next?  I am logging all phone calls and names. 
Pam T.
on 10/16/06 6:28 am - Saginaw, MI
What does your surgeon's office say?  Have you spoke to the benefits coordinator at your job to see if they can make any calls for you?  Just keep calling... eventually someone will have an answer.   Let us know how it goes. Pam

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wildgardener
on 10/16/06 12:07 pm - Knoxville, MD
The surgeons office said that Aetna acknowledges that they made a mistake when they told me that it was a covered benefit.  I guess I will appeal based on that.  Thye originally denied me saying that I needed the 6 month diet.  Youd think they would have just said that it was not a covered benefit then,  instead of after paying for xrays, reflux tests,  multiple surgeons visits and blood work.  I hope they dont try to withdraw payment for that .  I had paid Gary Viscio after the first denial, but he is apparently out of town this week so I was unable to ask him for advice.  I have they exact times that they told both me and the surgeons office that I was covered.  I feel emotionally exhausted right now.  I had arranged child care - hard to find when you have 4 children. I hate to think how much time, gas money, etc . . .  My 4 year old saw me crying and told me to talk to God - I still feel like screaming inside, but he was so sweet- it helps to try and focus on the good things I have.  Even my skinny little 17 year old with the occassionally huge attitude has been very sweet tonight while inhaling the sugar free jello I had stocked up on for after the surgery. 
fed-up
on 10/23/06 1:02 am, edited 10/23/06 7:30 am - Raleigh, NC
I am so sorry wildgardener.  Whoever is in charge of these insurance comapnies decisiosn is STUPID. Health costs for a lifetime VS WLS =   NO BRAINER WILD!  I just found out, please double check your plociy, but as of September 2006, updates were made. In lieu of the 6 month diet plan, you can do a 3 month multidisciplinary preparatory regime.... you need a shirnk, dietician, and dr to document diet, exercise and behavior modification, and here's where I am a little cornfused...I THINK this can be done by your bariatric surgeon and his/her center of specialists. ?   Give it another look now. Holy God I am thrilled if this is true. I heard it once today by an Aetna pre cert rep, but I have another call in just to be sure.
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