RNY scheduled 7/27 and no approval yet from Aetna---what to do?
Hi all,
I am scheduled for RNY next MOnday, 7/27. I met with my surgeon on 7/1 and that's when she scheduled me for that day, saying that the paperwork would go to Aetna within 24 hours and that would be plenty of time.
Long story short--Aetna didn't get anything until this past Tues, July 14 (which I am really aggravated about, but that's another story). I did lots of calling to both sides and now Aetna has it but the status is still 'pending'.
The 'customer service' people I've spoken to at Aetna are not too forthcoming--I've heard "It can take 6 weeks" to "it can take 30 days' to "you'll hear before 7/27." I am so frustrated. I am no way mentally preparing for this surgery, not to mention the stress of already submitting the proper paperwork to my job to let them know I'll (allegedly) be out 7/27, and thinking that I'm going to have to tell them "Sorry! It's going to another day!" not to mention care for my kids, which I haven't arranged yet.
How late did your approval come in? I am really very stressed over this. Any words of wisdom are appreciated.
Thanks in advance,
Michelle
I am scheduled for RNY next MOnday, 7/27. I met with my surgeon on 7/1 and that's when she scheduled me for that day, saying that the paperwork would go to Aetna within 24 hours and that would be plenty of time.
Long story short--Aetna didn't get anything until this past Tues, July 14 (which I am really aggravated about, but that's another story). I did lots of calling to both sides and now Aetna has it but the status is still 'pending'.
The 'customer service' people I've spoken to at Aetna are not too forthcoming--I've heard "It can take 6 weeks" to "it can take 30 days' to "you'll hear before 7/27." I am so frustrated. I am no way mentally preparing for this surgery, not to mention the stress of already submitting the proper paperwork to my job to let them know I'll (allegedly) be out 7/27, and thinking that I'm going to have to tell them "Sorry! It's going to another day!" not to mention care for my kids, which I haven't arranged yet.
How late did your approval come in? I am really very stressed over this. Any words of wisdom are appreciated.
Thanks in advance,
Michelle
Michelle
At the time I had surgery I also had Aetna for my insurance. They have 30 business days to either approve or deny the claim. About 2 weeks I got a letter stating that they did not get all the required paperwork. I called the office manager at the surgeon's office. She said she did send everything and she would contact the insurance company. It then took Aetna another two-three weeks to contact me with approval. My surgeon's office would not schedule a date until they got the approval letter.
Take deep breath and try to think positively. I know it is frustrating during this time. Things will work out. Good Luck!
At the time I had surgery I also had Aetna for my insurance. They have 30 business days to either approve or deny the claim. About 2 weeks I got a letter stating that they did not get all the required paperwork. I called the office manager at the surgeon's office. She said she did send everything and she would contact the insurance company. It then took Aetna another two-three weeks to contact me with approval. My surgeon's office would not schedule a date until they got the approval letter.
Take deep breath and try to think positively. I know it is frustrating during this time. Things will work out. Good Luck!
Never easy is it ? I was one of the lucky ones - and insurance was not a problem - had my date from the surgeon and assumed insurance had already approved ( why would they schedule w/o approval ?) but then got a letter in the mail so..... evidently they do - I think they USUALLY know what they are doing - so if they scheduled - they are probably pretty confident - don't tell the kids until the last minute anyhow - they don't need to worry - have your support people set up and if it doesn't happen - take if from there - I know it's frustrating !! I'm here for you need me !!
Highest (that I know of) 285 Weight when I started the process 277
Night before surgery 263 Goal weight 160
Smile ! You'll make the world a happier place !Inspriational video "Strive for Perfection, Settle with Excellence !
OH Support Group Leader
OMG! OMG!
I CAN'T BELIEVE I'M READING THIS!!!!
Let me guess have you had to deal with Tania at Tufts????
I'm going through the same thing.... She called me a month ago gave me my surgery date told me she would call me ina week with a pre-op appt... well 3 weeks went by and I finally called after 3 attempts and I told her that my surgery is in 2.5 weeks and I can't give my employer a days notice for appt... She said it won't be a days notice and got annoyed with me and I said to her I would not be calling if she hadn't told me she'd call in a week and she then stated " this isn't my only job you know" I was soooo mad.... My pre-op is July 31st Surgery Aud 5th lets hope all goes well....
so then Last week I called my insurance for ****'s n giggles to see i f I'm approved I have not received anything... GUESS WHAT THEY HAVE NO RECORD OF MY SURGERY!!!!!!!!
So I called the lovely Tonia and she said Oh it's pk I'm doing the paperwork today and they always approve with your insurance ( Ok what is it they say about assuming) we trust me I'm not taking her word that they will approve and $80,000 surgery and I'm stuck with a bill... I DON'T THINK SO...... I called Bc/Bs yesterday they still have no record I'll give it to Friday.. then heads will roll if paperwork still not done.... lol I will be writing a nice letter to Tufts while I'm recovering that having this surgery is stressful engough especially during the final weeks that we don't need this aggrevation. or atleast explain the process to us instead of giving us the run around...
Ok I feel a little better but not 100% untill I know I'm approved...
I feel your pain!!!!!!!!!!!!!!!!!!!
I CAN'T BELIEVE I'M READING THIS!!!!
Let me guess have you had to deal with Tania at Tufts????
I'm going through the same thing.... She called me a month ago gave me my surgery date told me she would call me ina week with a pre-op appt... well 3 weeks went by and I finally called after 3 attempts and I told her that my surgery is in 2.5 weeks and I can't give my employer a days notice for appt... She said it won't be a days notice and got annoyed with me and I said to her I would not be calling if she hadn't told me she'd call in a week and she then stated " this isn't my only job you know" I was soooo mad.... My pre-op is July 31st Surgery Aud 5th lets hope all goes well....
so then Last week I called my insurance for ****'s n giggles to see i f I'm approved I have not received anything... GUESS WHAT THEY HAVE NO RECORD OF MY SURGERY!!!!!!!!
So I called the lovely Tonia and she said Oh it's pk I'm doing the paperwork today and they always approve with your insurance ( Ok what is it they say about assuming) we trust me I'm not taking her word that they will approve and $80,000 surgery and I'm stuck with a bill... I DON'T THINK SO...... I called Bc/Bs yesterday they still have no record I'll give it to Friday.. then heads will roll if paperwork still not done.... lol I will be writing a nice letter to Tufts while I'm recovering that having this surgery is stressful engough especially during the final weeks that we don't need this aggrevation. or atleast explain the process to us instead of giving us the run around...
Ok I feel a little better but not 100% untill I know I'm approved...
I feel your pain!!!!!!!!!!!!!!!!!!!
Melissa M.
HW 250/SW 217/CW 117/ 1st GW 133/ 2nd GW 117
Reached my goal!!!!!!
HW 250/SW 217/CW 117/ 1st GW 133/ 2nd GW 117
Reached my goal!!!!!! 
Sorry to hear that you all have had problems with Tufts but I just wanted to share that my partner and I both had surgery @ Tufts in the last 6-8 months and we never had any issues like you guys had with them....one of us was approved immediately (Blue Cross) and one of us was denied (MassHealth) and Tufts had to appeal the decision...Tania worked with us on an almost daily basis to help get the approval and never was rude....she was always helpful, as was the rest of the team at Tufts....we still have contact with her at times and she has always been great! sorry to hear your stories but I guess everyone has a different experience.
Except for the insurance snags, my experience at Tufts has been wonderful. I can't imagine a better team of people to work with. I too will have Dr. Kim--I love her! How was your surgery and recovery? How are you and your partner doing now?
When I (hopefully) look back in a year, I won't remember this aggravating chapter of 'getting to the RNY.' Everything else has gone very smoothly. Worst case scenario right now is that my surgery gets pushed back 2 weeks, which is not a major problem.
I would love to hear the particulars of your surgery experience!
When I (hopefully) look back in a year, I won't remember this aggravating chapter of 'getting to the RNY.' Everything else has gone very smoothly. Worst case scenario right now is that my surgery gets pushed back 2 weeks, which is not a major problem.
I would love to hear the particulars of your surgery experience!
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