I am new to posting here and I am super frustrated!  I started my journey on July 21st.  My surgeon made me feel like it would be a pretty easy process and I expected to have my procedure by Sept. 18th and then I got my first denial.  I have 22 years worth of weigh****cher books.. I can show my weight for 22 of the last 26 years and sadly my BMI always qualifies me with the exception of a year or two.  On the first denial they said I needed 3 months of surgeon-supervised diet...........SO..........we did that..and re-submitted.  I just got my second denial and their reasoning makes no sense.. there is just jumbling of words that make no sense and when I call AETNA the representatives don't have a clear answer.  When my surgeon's office called they were given two different reasons by two different reps.  I am at a loss as to what to do.  I am going to try and get an attorney's advice and we filed another appeal yesterday..  I have an Aetna PPO that is supposed to cover this, providing your BMI meets requirement and you have the 3 month supervised diet.  UGH...................PLEASE advise if you have any suggestions..

Congratulations!!!!!  The 23rd will be here before you know it! 

What was the outcome???  I am in the process of trying to figure out if I will be approved based on my BMI not being over 35 for the past 5 years,

Congratulations Amy.  How long did it take to get the approval?  Mine was submitted over a week ago but haven't heard anything yet.  I'm on pins and needles.

Good luck!
Jo

     FYI - I was approved by BCBS (verbal to Dr's insurance clerk) back in Nov. of 2007.  We got all the info together, set a date and sent the letter for final approval.  A BCBS rep called back to ask the Dr. to wait until after the first of Jan. 2008 due to some "issue".  It's been too long and I don't remember the exact details.  Any way, The Dr.'s office called and asked me about waiting and since I didn't really have a problem with it, we agreed.  After the new year, the Surgeon's office wrote for the final surgery approval.  The Dr. was casually advised that as of Jan. 01, 2008, my BCBS plan no longer covered ANY weight loss process.  They wouldn't even pay for a Dr's office visit if the sole purpose was regarding weght loss.
     I was totally out of luck for 3 year.  I didn't even know they had added WLS back on until Nov. of last year when I got my new benefits booklet and ACCIDENTLY saw the surgery listed at the very back of the book. 
     I immediately got back with my surgeon and BCBS had turned me down 3 times.  Finally I got a tenative approve but first I had to do a 6 month (180 day) diet.  At the end of the 5th month of the first diet period, my bariatric surgeon was advised that BCBS had just changed their requirements and the 6 month diet had to be completed with my PCP, not the surgeon.  Here we go again I thought!  I had to start all over again with my PCP doing the 6 month diet.  I joined Weigh****cher's too, just to be on the safe side.  So instead of failing on a diet for 6 months, I ended up doing it for 11 months.  Nothing like BCBS making sure you end up feeling like a complete and utter failure for as long as they possibly can!
     I have finally been approved for RNY and have a surgery date set for 11/29/2010.  I won't believe it until I am in recovery and my guts have been cut out!  I don't trust BCBS any further than I can throw their building! 
     The lessons here?  Get your approval in writing from your insurance company and get the surgery completed as soon as you can comfortably afford to do so!