ANY HELP? - I am lost

I told myself not to get excited about this until it was over and now I am devastated......I am schedule for my RNY in 10 days and I got the call today that my insurance does not cover any WLS. I called Aetna almost a year ago and asked over and over to make sure I was covered. I gave them the medical codes and everything and they told me yes and gave me the criteria for the surgery. I have spent the last 9 months getting all of the consults and tests and NOW that it is less than two weeks from surgery my Dr's office called and said that Aetna said it is not part of my policy. Actually first they told them no and then they called a different dept at Aetna and they said yes it was covered and told them to fax everything over and them another higher up told them that the other people were wrong and that it is a common mistake by customer service people. Shouldn't they know what they are talking about when you give them your policy number and group info........WHAT CAN I DO NOW? DO I HAVE ANY OPTIONS WITH FIGHTING THIS?

Well friend, say hello to Mexico!  I really don't think you'll have much of a chance of fighting for an unapproved procedure.  Since you've come as far as you have, testing and all, you might want to investigate financing and near shore options.  I know most people can't swing the cost outright, but you may be able to get it done for under 13K and finance it over long period of time. Don't let yourself get too far down on this.  Test your probe into getting approved and similtaneously check out the more affordable options. BTW, just got my insurance bill for RNY in Pennsylvania.  33K.  And if I would have been turned down I was heading south.  I'd give up my Hummer to be healthier. Good luck and keep your head up. Guy

Hey matt.. since you have gotten several answers...go to your HR Department...have them contact their insurance rep..to find out if it is covered or not... example... I have UHC...through AIG...AIG big company when I called UHC...a general UHC rep said no...but then I got higher up the food chain who looked at our policy...the answer was yes... so tell them you want a copy of the policy...they have to give you a written policy... now...there might me the option, that the policy changed at the first of the year....ick suit up man..get the right answer from the right person....take names..and tell them you are taking notes...and note the time....and when they try to give yo the run around...tell them you know they want to give great customer service...and that you will wait.... good luck

I just found my exclusions on my employers handbook for Aetna and this is all it says now......
Exclusions

Treatment of weight loss when another underlying severe medical condition is not present; outpatient prescriptions are NOT covered even when there is an underlying medical condition. 

I have sleep apnea and Asthma ...both linked with weight ( on CPAP) and both my parents have heart disease. Don't you think this would qualify me according to this wording?

Damn Matt....this is like picking gnat **** out of pepper.. Please do not hole me to the fire on this...but the way I interpret this is...the Sleep Apnea is an over laying problem... You have Sleep apnea because you are heavy..you are not heavy becuase you have sleep apnea... get the rep to make a decision...most companies are more yes or no...this sounds gray good luck

I had some pretty bad sleep apnea. I would say that the sleep apnea enjoys a symbiotic relationship with obesity, and it is difficult to identify the miscreant in the relationship. Fat people snore and suffer sleep loss, among other things.  Sleepy people seem to crave comfort food.... and the downward spiral prospers under this unholy marriage. Funny thing, I went in for a sleep study about six months prior to considering WLS.  My snoring was causing myself and my wife grief.  Cramming my yap full of pizza every night wasn't helping matters either. The techie wired me up and down for the count I went.  After he woke me up, he said that he would call me with the results.  Two weeks later the call came, no apnea "events" were observed A few months later I was seeing my doc on another matter (also weight related, BTW) and he asked how my apnea has been.   "They said I don't have it", came my reply. "BULL****"!  cried my doc, who had read the report in my file.  "It says right here that you had SEVERE events all that night". I guess the techie who called me with the results could have used a few winks his own damn self  Asshole.

"Fat people snore and suffer sleep loss, among other things.  Sleepy people seem to crave comfort food.... and the downward spiral prospers under this unholy marriage." Great post and so, true Baja! The 10 years or so prior to WLS, I averaged around 3 hours of sleep every night. Snored like a frickin' banshee and ate my way from 300 to around 500 pounds. I had no clue of the impact of this "unholy marriage" as you so eloquently described. I had a couple sleep studies done prior to WLS and they also found out I had an extreme case of sleep apnea. During the studies, I would stop breathing altogether several times a night. The doctor told me I would be soon headed for the big sealy posturepedic in the sky unless I started using a bipap machine and lost weight.    I don't blame sleep apnea alone for my weight gain cause God knows I have plenty of other contributing factors but let's just say, it was a big contributor. Anywho, no more sleep apnea and I get in a good 6 hours a night so WLS to the rescue, again!! Terry

sorry to pop back in here... a lot of companies have different areas...for treatment of Weight loss and bariactric surgery

Matt - I am a bariatric nurse coordinator - SLEEP APNEA ESPECIALLY IS A SEVERE UNDERLYING CONDITION.  FIGHT THIS TOOTH AND NAIL.  If you can't get any help from the nurse coordinator at your program, please let me know.  This should be appealed to the Nth degree. Sorry for lurking on the mens' board, but it help me understand my guy population and the issues they deal with, especially as I have about 90% women. Mary

(what Mary said) ..  I'm not a big fan (no pun intended) of "obesity law attorneys", but I'd say in this case you have the ins. co., hands down!    You also have a good case under a theory of "detrimental reliance", in that all along they have said you are covered and now, after you've spent time and money on that asumption over time, they try to change postiion ..  the law might say, in fairness and equity, they are "estopped" now to claim otherwise ..     good luck!