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Yay! Congrats!!!!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
Just updating to let everyone know i was APPROVED as of yesterday!!!!! 
HW: 401 SW: 297 CW: 200.8
RNY gastric bypass surgery on March 5th, 2013
This thread is really old, so I hope you don't mind me responding. Here is Walter Lindstrom's website, where you can find contact information.
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
Sorry to hear that. I guess your only option would be to have your doctor write a letter asking them to expedite the appeal process for dire medical reasons, and then explain the hernia. Hopefully it won't take the full 8-12 weeks. I wish you luck!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
They said they will not accept any new information, I did go in again this month on the 31st which would technically give me about 120 days but she said my only option is to do an appeal at this point.
I am not sure you can get them to expedite an appeal. It certainly wouldn't hurt to try it, but I'm not sure of the process.
Instead of appealing, can you do 3 more days of the program, and then resubmit your paperwork to Aetna? That might be faster. And, I have heard that Aetna is notorious for being strict about the 90-day program - so I am not sure where the doctor's office lady gets her info. They want at least 90 days. If you can see a doctor now, and have them write down your current weight, what you've been doing since the 88th day of the program, and document your vitals, maybe that will be enough to qualify for the 90 days. The 90-day program does not have to be a specific "program" per se, there are just certain criteria that need to be met, and you need to be dedicated for at least 90 days.
Good luck!
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
I am not sure, I think the lady at the doctors office wasn't really trying to do her job. She just called me back and said she talked to Aetna and they said it was denied because I did 88 days and not 90 and that now I have to send in an appeal letter. She said they have never seen them be this strict before and that this has never happened. So now I need an appeal letter example and need to know how to get Aetna to expedite it.
What do you mean by "that my plan does not cover me doing a 90 day program?"
HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"
M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)
Thanks for the info. The 90 days would have been up by the time my surgery was suppose to be in December, they are actually asking for a 3 yr weight history which is now moot because I had a weight taken this year which gives me 3 years of weight history now. The issue now seems to be that they are saying that my plan does not cover me doing a 90 day program which makes no sense because that is not what they told me when I called before and during the process. Aetna is telking me the only thing I can do is have the doctor do a peer to peer or do an appeal.
Hockeymom87 · 0 replies · 645 views
