Recent Posts
Topic: RE: DENIED BY AETNA ON APPEAL
Hi Rosie,
Would you mind sending me the letters that you have drafted? I am concerned because I have to a 5 year weight history and my weight history hasn't always been with a BMI of 35 so I need all the help I can get to get the insurance company to approve. I'm trying to do surgery prior to the end of the year so I need a quick approval. Thanks! My email address is [email protected]!
Would you mind sending me the letters that you have drafted? I am concerned because I have to a 5 year weight history and my weight history hasn't always been with a BMI of 35 so I need all the help I can get to get the insurance company to approve. I'm trying to do surgery prior to the end of the year so I need a quick approval. Thanks! My email address is [email protected]!
Topic: RE: Anyone know of a Complications Insurance Co.?
Google information about Blis Insurance Company.
SW/CW/GW 224/140/135
5'2" no pre-op diet
5'2" no pre-op diet
Topic: Medical Spending Account
Hi. I still have money in my medical spending account that I'd like to use or lose by the end of the year. My insurance is not covering my VSG so I am self paying. Question - can I make a claim against my medical spending account?
Let me know if y'all know.
Thank you!!
Let me know if y'all know.
Thank you!!
SW/CW/GW 224/140/135
5'2" no pre-op diet
5'2" no pre-op diet
Topic: RE: I FOUGHT for an approval..and GOT IT!!
CONGRATULATIONS!!! I am happy for you!
I couldn't agree more when you say 'no one wants it more than me'. That is how it was for me as I put together my own appeal and also my daughters and won both with Aetna also. You have to take it into your own hands and fight hard for yourself because no one is going to fight a hard as you want it!
Both of my sons were just recently approved and they are having surgery December 13th!!
Good Luck to you and Congratulations again!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: I FOUGHT for an approval..and GOT IT!!
Glad it finally went through for you. I had read your prior postings and couldn't understand why you were denied.
Congratulations!
Congratulations!
Kim
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet." Erma Bombeck
Topic: RE: Denied by Cigna
Just keep working towards it. I had finished the 6 month program with my doctor but the insurance company did not like the way it was documented. I restarted a new 6 month program and got 3 months into the program, when I got the call that the insurance company had reconsidered and approved it.
JillinWarren
on 11/7/10 12:55 am - Warren, NJ
on 11/7/10 12:55 am - Warren, NJ
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
That is what I think!
Exploring alternatives......
Exploring alternatives......
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
I am sooo sorry! I'm having problems with getting insurance to approve mine right now even though I totally qualify for a revision. Do you have another surgeon around that you can go to? I probably wouldn't go to him anyway now even if he did decide to "take it" again. What he did was very unprofessional to you.
Topic: Denied by Humana
Today I received my first denial for lap band surgery. While I was told by friends to expect a denial the first time, I am disappointed. I thought I did everything correct.
I am now going to appeal, but first just wondering what others experience has been with appeal and humana.
The denial states "available documentation does not indicate that this patient has a primary care physician who has followed her pre-operatively, agrees that she should have the procedure performed, and will follow her post-operatively after procedure is performed."
This to me sounds like maybe some information was not submitted to them. I did the 6 month supervised diet, and have the bariatric referral form from my primary care doctor.
Any comments? Thanks.
I am now going to appeal, but first just wondering what others experience has been with appeal and humana.
The denial states "available documentation does not indicate that this patient has a primary care physician who has followed her pre-operatively, agrees that she should have the procedure performed, and will follow her post-operatively after procedure is performed."
This to me sounds like maybe some information was not submitted to them. I did the 6 month supervised diet, and have the bariatric referral form from my primary care doctor.
Any comments? Thanks.
Topic: I FOUGHT for an approval..and GOT IT!!
HI everyone. Many of you have helped me in my dealings with Aetna and my employer's denial for my WLS. I am happy to say that after it was reviewed again on Thursday teh 4th.. I have an approval! I had to take it all in my own hands and know deep down in my gut that no one was going to want this more than ME. I got all my paperwork organized..sent ton's of faxes when requested, highlighted, paperclipped, tagged and had extra appointments and calls with my dr., the barix clinic and the insurance offices..but it paid off.
I knew I had did everything on my end. You have to fight for it. Unfortunately the first medical reviewer I had with Aetna denies 99% of the claims to have WLS but I didn't stop there. I started in December of 2009 and here we are almost a year later.
Don't give up. I am here to tell you to fight for what you want and if your insurance company does have it in their plan to pay/help pay for WLS..do what they say to a "T" plus some.
Excitedly waiting for my own WLS date!!
Angie
I knew I had did everything on my end. You have to fight for it. Unfortunately the first medical reviewer I had with Aetna denies 99% of the claims to have WLS but I didn't stop there. I started in December of 2009 and here we are almost a year later.
Don't give up. I am here to tell you to fight for what you want and if your insurance company does have it in their plan to pay/help pay for WLS..do what they say to a "T" plus some.
Excitedly waiting for my own WLS date!!
Angie
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