It CAN Happen!

Hello All, I submitted a post a few days ago about resubmitting my info to Aetna. I was originally denied back in November 2004 for lack of a supervised 6 month diet. I began my consecutive months in January 2005. Last week, I submitted 5 months of PCP supervised visit notes, exercise program, monthly exercise progrm receipts, nutrition notes, & nutrition receipts. I was a little apprehensive about submitting this info "early" but I have my 6 month appointment scheduled in another week. I turned in everything on Friday. My surgeons office was closing but they let me in to turn in my paperwork. That weekend was a holiday so I figured the absolute earliest my surgeon's office could turn it in was on the following Tuesday. Well, I got the call 3 days later. I have been approved. Yes, I am excited, but the turnaround was so quick and I was truly expecting my 4th denial. I'm happy, but it is a touch bittersweet as well. I'm sure that everyone is here because they have either been denied, don't want to be denied the first time around, fighting an exclusion, need clarification, or just a huge cheerleader/supporter (Donna Chu). It's hard to be happy because I know there are so many out there that NEED this surgery that have not been approved yet. I've been here with everyone else seeing others so happy to be approved and just wanting so badly for it to be you as well. I've chalked up some of this as to luck. Why would some be approved and not others? Some submitted "books" of documentation and still get denied whereas others are able to write out their "history" and get an approval. Some have loads of co-morbids, while others have very few. The point is that we probably ALL need this because the common person would not elect to have a surgery just for the heck of it! What I have done for the past 6 months is really no different that what I've done for more than 10 years. But, in the past 6 months, I have learned patience, committment, formed a wonderful relationship with my primary care physician, and really evaluated my heath and it's importance to me. So, it is not all bad. There are some good things that happen along the way. Don't give up on your quest for surgery. Continue to celebrate other' successes and root for those who are still waiting. Be persistent, be an advocate for yourself and use any and every available resource. I truly hope that everyone here gets what they are looking for. I plan to continue to lurk on this board as I have done for so many months to see how everyone's journey unfolds. Good luck to each and everyone of you. Courtney okay, I admit it. I'm also hanging around to catch a glimpse of Gary Viscio as well. How cute is he! from Ms. Viscio

CONGRATULATIONS Courtney!!!!! I am so happy for you! Good luck with your WLS and keep us posted. I know that hearing success stories, especially when people have overcome denials, appeals, etc, really helps to motivate me. Thank you. Tammy

Thank you Tammy!

Donna doing the Happy Dance for you Gary is wonderful and is out here fighting for our rights. YOU GO GARY!! Donna 338/215 -123

Thank you Donna!

I'm getting ready to turn in my paperwork to Aetna too. I did the six month diet but I did four months of it last year than the last two months last May and this June. Their clinical policy bulliten says the diet does not need to be six consecutive months. Only three of the months have to be consecutive. I'm still a little worried about how they will percieve what I've done. I have good reason for this. My seventeen year old son got in with a bad crowd and began using drugs and alcohol very heavily. He was very disrespectful to my husband and I, he was hateful and cruel to all the members of the family. He stopped going to school, he was sneaking out at night and was usually gone all night. Then he'd sleep all day. We finally turned him in to the police and then we put him in a program called "The Drug Court Program." The kids in this program have some very strict rules to follow. Curfew is a eight o clock, Ab****ely no sleepovers. No fraternizing with anyone who uses drugs or anyone you had gotten into trouble with before. The child must attend school and pass all his classes. There are drug test done on the child on a regular basis. The child and the whole family must participate in therapy. There is substance abuse therapy for the youth and for the parents there is a support group meeting as well as family therapy. Once a week the child is to go to court and stand before the judge and report on his/her progress for that week. If they don't do what is expected of them, they are put into detention and if detention doesn't do the trick, they go to a place called Genesis, which is basically a work prison for the youth. In detention they might sit around and read or watch tv but in Genesis they work. I've seen some hardened kids enter this program and come out wise, loving, awesome men, not boys any longer, but men. It has done wonders for my boy. But it has been more than stressful. I developed depression. I thought for a while that my marriage was ending. It has been a hard road to trudge. The diet that Aetna wanted kind of just went out the window. My family and marriage was falling apart, how could I possibly be worried about Aetna's silly diet? So, I have a pretty good excuse for stopping the diet after four months but I don't know if Aetna will understand. Another thing that worries me is tha I don't have all the documentation you have. I have my doctor's notes. His notes discuss my diet and what I am doing for exercise. But I have no receipts for a trainer. I just did my exercise on my own and discussed it with my doctor. I went to a dietician last year and I have a receipt for that and I have the records from my visits with her. There isn't much there just a page or two. I've got a copy of the diet itself. It sounds like you went to your doc regularly, your nutritionist regularly, and a gym regularly. So you have notes and receipts for all three. I don't have that. Oh, I hope that doesn't come back and bite me. Well, all I can do is my best. If my best isn't good enough, then Aetna will have to be real clear about what good enough for them. And then I'll have to make sure my best lines up with what they want. Oh, I'm beginning to make no sense. Time for bed. Congratulations. Keep me up to date will you? I need to get more of a feel for how Aetna works. Lynda D.

Wow Lynda, You have alot on your plate. I am so glad that your son is doing better. Stress, can really wreck havoc on your family, I am praying that everything will work out for all of you. If you find that you are feeling depressed, you might want to go see your docter. When we are depressed there is a physical response that will inhibit seratonin getting to your brain. Seratonin is what makes us feel happy. There is medication that will get that necessary seratonin to your brain and make everyday somewhat easier for you. The medication and/or therapy may really help what is going on with everything that you are dealing with. My sense with Aetna is that they just want the necessary paperwork. Make sure you make a specific weight appointment with your PCP for July just in case they don't accept the 6 months not being consecutive. Make sure that your docter has noted that you are excercising and how often. You might keep an exercise journal as well and submit that. I'd also make another appointment with a dietician or nutritionist. Some of them will even allow you to pay and then do phone sessions and fax you the notes once if you are unable to find the time to go see them. This whole journey is very important but so is your marriage and family. Seek help anywhere and everywhere that you can. Feel free to e-mail me if you'd like. Good luck to you! Luv, Courtney