DENIED by Aetna and absolutely devastated x-post

I just found out that after everything I've gone through, Aetna denied me yesterday.

The reason--my BMI the one time I was weighed in 2007 was 33.9.  I had just had a baby, and during my pregnancy I lost 40 lbs (I had Hyperemesis Gravidarum, where I basically vomited all day every day the first 22 weeks of my pregnancy).  The weight was taken at my postpartum visit.

I have been obese my ENTIRE adult life.  The only 3 times I lost weight were when I had my 3 kids, and was violently ill with all three.  The weight of course came back on w/in three months.  But, I have no proof of this.  

I am devastated.  I have spent over $1000 in co-pays and insurance balances doing the program at Tufts Medical Center.  I cannot believe I am not going to get my surgery.  I have been at this since January 1st.   Now it's over.  What can I say in an appeal?  I mean, that's what I weighed for about two months.  Now I can look forward to a life of more failed diets and just no chance to ever get healthy and thinner.


Thanks for listening, now and for all the other times I've posted.

Awwwww sweety, I am so sorry, please just know you are not alone. The first time I applied for RNY was 4 years ago, the second time i applied was 3 years ago, the third time i applied was 2 years ago, and the forth time I applied was November 2008, and I was finally approved 2 days ago on August 10th 2009, my surgery date is for September 14th 2009.

I went through all the tests 4 times, all the physic evals 4 times, the co pays 4 times, switched insurance companies 3 times, and had countless nights where i contemplated suicide and cried myself to sleep.

Trying to get WLS is a very long uphill battle, but when it finally happens, none of it matters.

All i can tell you is that there is only ONE insurance company that REALLY approves! And that is Blue Cross PPO. Now for me, I had to go under the MRMIP program that blue cross/state offers, It is Major Risk Medical Insurance Program. A normal insurance company wouldn't accept me because I am in the super morbidly obese category with a BMI of 57. I pay $400 a month for my insurance, and we are living hand to mouth to pay for it, but if it gets you your surgery, then its worth it!!!!!

Now, here is where you need to start, I was lucky enough to get an agent at Blue Cross that really cares, her name is Breanne, without her I would not have gotten this surgery!  Her number is 1-800-713-5331. She will explain all your options, and she will give you an insurance that is GUARANTEED to approve you!!!!!!!!!!!!!! Let her know that Tatem Kennedy referred you for insurance to cover gastric bypass.

Please let me know if this helps and stay in touch, and i will always be here for you if you need support/advice!!!!!!!!!!!!!!!!!!
-Tatem

I'm so sorry to hear that you are going through this. I am also battling my ins company. I cannot have a RNY or the Lap-band due to health restrictions.  I need the VSG procedure and they don't cover it without certain criteria which I have and yet they still deny. I am in the Level 2 part of my appeal. Do you have any Doctors that can give you written recomendation for the surgery? I have been to a variety of different doctors and I have received support letters to send with my appeal. I have one thing to tell you...DON'T GIVE UP. That is what they are trying to do and if you keep trying you may win in the end. If I can help in any way please feel free to PM me. I may be able to help with your appeal.  I wish you all the luck.  Remeber you are not alone.

Hugs, Tiffany

 now it doesn't matter because you got the news!!!!!!!!!!!!!!