Aetna LB revision question (cross post)
Hello everyone - I am a newbie to this site and am looking for some help with Aetna
Question for those of you with AETNA seeking revision from LB to VSG - how did you get AETNA to pay? My band has a severe prolapse (documented with GI, showing that barium just sits on my espohagus causing reflux and spasms. Originally had lost 130 lbs and have regained 30.
When I got banded in 4/2010 AETNA approved the proceedure in 48 hours. And I was very happy with the band and my weight loss. Flash forward to 5/2012 when I began being unable to eat solid protein, but could eat things like saltines with out any problem!
Made an appt for a my first ever fill 3cc and have been so unhappy since. The doc removed the fill completely in 6/2012 and then sent me for an GI in 7/2012 and called me last week and doctor is suggesting revision to sleeve. Think it would be best for me as I have battled nausea and reflux, for quite sometime now.
Thinking that he must feel that my case is valid and AETNA will approve, but I am worried. So - those of you with AETNA who were able to revise, please tell me your experience and what your approval process looked like.
Did AETNA treat the revision from LB to VSG as a new surgery? Meaning did you have to requalify for the surgery or were you able to just get the revision to VSG approved with proof of the problem?
Hoping that they will approve soon as I have pain and the doctor is concerned about my needing the procedure done as an emergency.
Also, were you able to have the LB removed and the VSG done at the same time? How long were you in the hospital for?
Appreciate any feedback or advice from those of you who have been there and done that!
Hoping for the best and preparing for the worst when it comes to dealing with Aetna!!
Tori
Question for those of you with AETNA seeking revision from LB to VSG - how did you get AETNA to pay? My band has a severe prolapse (documented with GI, showing that barium just sits on my espohagus causing reflux and spasms. Originally had lost 130 lbs and have regained 30.
When I got banded in 4/2010 AETNA approved the proceedure in 48 hours. And I was very happy with the band and my weight loss. Flash forward to 5/2012 when I began being unable to eat solid protein, but could eat things like saltines with out any problem!
Made an appt for a my first ever fill 3cc and have been so unhappy since. The doc removed the fill completely in 6/2012 and then sent me for an GI in 7/2012 and called me last week and doctor is suggesting revision to sleeve. Think it would be best for me as I have battled nausea and reflux, for quite sometime now.
Thinking that he must feel that my case is valid and AETNA will approve, but I am worried. So - those of you with AETNA who were able to revise, please tell me your experience and what your approval process looked like.
Did AETNA treat the revision from LB to VSG as a new surgery? Meaning did you have to requalify for the surgery or were you able to just get the revision to VSG approved with proof of the problem?
Hoping that they will approve soon as I have pain and the doctor is concerned about my needing the procedure done as an emergency.
Also, were you able to have the LB removed and the VSG done at the same time? How long were you in the hospital for?
Appreciate any feedback or advice from those of you who have been there and done that!
Hoping for the best and preparing for the worst when it comes to dealing with Aetna!!
Tori
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