My RNY was been postponed a 2nd time; Aetna STILL hasn't made 1st decision

As you may have been in my previous posts, after going through a 3-month multidisciplinary program at my hospital, I finally had my surgical appointment on July 1.  She thought everything looked good to go so scheduled RNY surgery for July 27.

After a horrible 3 weeks of my phone calls back & forth between Aetna and my hospital trying to facilitate the process (Aetna kept saying they didn't have this or that paper, etc), there was still no answer on Fri 7/24 so the surgery was cancelled.  Needless to say, I was very disappointed, but the surgery was rescheduled for tomorrow, August 11.

Well you can see where this is going.  Still no answer as of Friday. I had submitted weights for the last 5 years to Aetna --my primary put a list together for the surgeon--but that list wasn't good enough.  THey call Friday wanting the actual OFFICE VISIT paperwork for all of those weigh ins!  So, I drove to my primary, they were wonderful enough to print everything out for me and fax it. 

As of this morning, the surgeon's office says "We'll know by 2 pm."  The stress of waiting today was really getting to me--I kept thinking, "I can't believe I'm possible having MAJOR SURGERY TOMORROW and it's 1 pm and I have NO IDEA." Long story short, it's sitting on the reviewing doctor's desk at Aetna still.  Surgery for tomorrow has been cancelled.  After two cancellations my hospital is not rescheduling (which is good, I guess, but makes me feel like I'm just flapping in the breeze with no end in sight)

I am so stressed, so sad, so fed up.  My kids start school in less than a month and I wanted this done before then ---they are only 4 and 5.  I also have a 2-year-old to consider.  I just wept when I found out I am back in 'limbo'; even if it is somehow approved (I am so not optimistic with Aetna), I won't have surgery for several weeks and it's going to cause many more problems than if the insurance co. hadn't stalled left and right and if my surgeon's office hadn't done their job so slowly.

I  am at work and I am sitting here just trying to stay composed.  I cried off and on all day.  I feel so defeated.  After researching for two years, I started making my phone calls the first week of January this year to Aetna, getting ALL of the requirements straight.  I've had a million doctor, nutrionist, psychologist, and behavioral therapy appointments this year, ticking off each Aetna requirement as I did it.   I  have done everything right.  I hear so many 'good' Aetna experiences, and so many horror stories.  Mine is turning into a horror stories.

Thanks for listening.  I wish I could go home and just hug my kids.  I was so anxious and was so short with them today, which I never am.  On top of everything else, I feel terrible about that.  This has been such a long summer trying to get approved.  I'm past disgusted and I'm just getting depressed.

Awwwww......I read this and can feel your pain through your post!  Hang in there, it will happen!  It sounds like you have done everything you are supposed to.  I was approved by Aetna on the 3 month multidisciplinary program....as a matter of fact was denied at first because my surgeon's office sent in the paperwork too soon!!  I wasn't even done with the 3 months (90 days yet) but the girl in charge of the insurance was new to the office and thought I could get approved b/c I had been going to WW for 8 months.  She submitted my paperwork WITHOUT me knowing and was going to surprise me....well you can imagine my surprise when she called and said "I tried to get you approved but apparently Aetna doesn't recognize WW as a dr supervised diet."  I was so upset....going through all the emotions you describe in your post.

So, I continued my program, had to file an appeal since I was 'denied' and within a couple of days was approved.   Once I did complete the 90 days, I put all the paperwork together MYSELF and faxed it to Aetna myself.  I think I faxed a total of 30 pages of stuff and followed through with them to make sure they received it.  In fact, I called my surgeon's office and told them I was approved instead of the other way around.  Sometimes you just have to take matters into your own hands.   

I do know they did want everything documented IN the dr visit notes, such as behavior modification, exercise, etc....so my PCP was very thorough about documenting all of the visits with the dietician in her office notes.  It wasn't going to be enough to have the dietician notes, the doctor notes, the proof of behavior modification classes, etc.....it all needed to be documented in the Dr notes is what they told me at Aetna.

Anyways, I just wanted to send you HUGS and tell you to hang in there!!  Don't give up and hopefully, your approval is on it's way.   Even though you are disappointed now, and understandably so, it will be all worth it in the end when your approval comes through.

Good luck to you and keep me posted on what happens!  I'm keeping my fingers crossed for you.  I remember how horrible it was when I got that denial letter and then waiting for my approval......it was honestly one of the most nerve-wracking things I have ever been through.

Nan