:-( Does This Mean What I Think It Means?????

"Conversion to a RYGB may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch,is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure. "- end quote Okay, when I read this I am thinking that Aetna may "deny" my surgery if I do not have adequate documentation showing that I was "compliant with a prescribed nutrition and exercise program" following my initial bariatric surgery which was gastroplasty 10 years ago.. I am trying to get a revision but wondering what will Aetna say once the surgeon submits the request for approval .. reading it what would you think.. Casey

casey i dont think you have anything to worry about. esp. since it has been 10 years since your surgery. what is your bmi? do you meet the criteria for gastric surgery by their criteria for surgery i.e. are you 100% over your bodyweight with co morbids or 200% over your bodyweight without co morbids? i am not familar with aetna but the excerpt sounds like they are talking about if you had the gastric surgery in the last 2-5 years or so...not 10 years ago. i wish you the best of luck. karen