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I don't know who or where Miss Missy is. All I know is during the time I had surgery (2009), her post was very instrumental in helping me ensure approval with Aetna. EP stands for Exercise Physiologists. Yes, the four consecutive months are crucial. You can view the first month as being the start of it all and the three consecutive months as your checkin. I started in August and had my last appointment in November. I ensured I went to a nutritionist and ep that were familiar with the bariatric surgery process. I don't know where you're located but you should be able to find someone. For the 2 years of weights I called all my doctors that I had seen during that time that I know had a weight for me. I pulled from my OB/GYN, Primary Care Specialist, I even went to the corner diet doctor that I had gone to see to get a copy of my records. I supplied all of those record copies to my physician and had her to write me up something. Now mind you, I had to do some modification to the original letter , but needless to say, I got it done and was approved within 4 days on the initial submittal. Had surgery 12/23/2009. By me having it at the end of the year, I was able to take advantage of all the OOP limits for the year. All in all I was OOP about $2500. Email me if you can... ericabaity at gmail dot com.
Take care,
Erica
Hi,
You seem very organized, so I'm going to jump start from you if you don't mind. First question: Who & Where is Miss Missy? Second: So you had four consecutive months seeing all three each month Primary Care appointment, Nutritionist appointment, and EP (what's EP). What letters did you have the write? Can I get a copy?. I'm pretty sure my specialist who deals with my stomach issues would help too. How did you give them exact weights for the last 24 months... Did you give an educated guess? Did you need doctors records to verify?
I want to use my time an co-payments wisely? Meeting insurance criteria can be frustrating... After the insurance paid, did you have any balance owing?
Thank you, trustJesus
Part of ObesityHelp is "HELP" and that is our priority. Please take a few minutes to show your support and help to other members that are having their surgery. A few days leading up to a member's surgery date and for a couple of weeks after can be stressful. Whether pre-op or post-op, it makes a big difference when we help each other. You can check out the Upcoming Surgery Dates and help other members by posting your support.
Let's make the journey together 
I didn't have to do an appeal, so I can't help you. I'm sorry! I just wanted to acknowledge you though. I hope you find help! Can your surgeon's office help you? That is who usually helps with the appeals.
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)
My insurance said that I needed 6 consecutive months of both doctor and nutritionist visits.
I am new to OH and have read that I need to first be accepted for WLS through my insurance before I start the 6 month required visits to see the nutritionist. Can anyone tell me if this is true? I have called my ins., (BC/BS), and asked them if they cover gastric bypass surgery and they said it is covered and then they went into my requirements, out of pocket, etc.
Any help you can send me would be greatly appreciated. I already know about the six months of doctor visits, etc. But, am confused on the first step.
Thanks!
Hi pharmagirl thanks and I will post in the revision forum.
Sorry you got denied. I have read other post of people with the same issues with their insurance co. You might want to post this question on the revision forum as well.
Hopefully they will approval after the peer to peer. Keep us posted.
VSG on 1/14/14 with Dr. Samuel Wasser
I had the lap band placed in May 2006, everything went well and I lost about 90 lbs. I started to have pain at my port site and noticed I no longer had restriction so I went it have it checked out. After the EGD it was discovered I have erosion. All pre op requirements done according to fepblue, but denied due to non compliance. So after 2 submissions to the insurance company now my surgeon has a peer to peer scheduled for tomorrow 1/2/14. Praying everything goes well.
Anyone have this type of experience?
Hi chinamomma I have fepblue and was also approved for the lap band removal but denied the RNY. My surgeon is also having a peer to peer review this Thursday. From your ticker I'm assuming your peer to peer resulted in approval?
T
Hockeymom87 · 0 replies · 637 views
