:-( Does This Mean What I Think It Means?????

"Conversion to a RYGB may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch,is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure. "- end quote Okay, when I read this I am thinking that Aetna may "deny" my surgery if I do not have adequate documentation showing that I was "compliant with a prescribed nutrition and exercise program" following my initial bariatric surgery which was gastroplasty 10 years ago.. I am trying to get a revision but wondering what will Aetna say once the surgeon submits the request for approval .. reading it what would you think..

I think you should not worry until something happens, if it does. Check out obesitylawyers.com for info on what things to submit. Make sure your surgeon submitts everything they need to. Good luck El

Denise, I believe you have a shot without the need for more money for a lawyer. Get your benefits book and really read it. I would be interested in hearing how it is worded in medical necessity, and in the appeals section.