Insurance Issues

Anyone here have Aetna and have had them successfully approve the sleeve procedure? I'm in an appeal process as they denied me for a 0.5lb weight fluctuation during their 90 day mandatory program. I tried last year for approval and they denied me for a 4lb weight fluctuation (my fault, behavioral habits that I have since adjusted), so I tried losing weight (again) on my own with no real progress. Any advice while I sit and twiddle my thumbs waiting for them to respond to the appeal?

Really, a half pound? That just sucks. The whole reason we all get surgery is due to struggling with weight. And they deny over a half pound, which could just be a water retention amount? Sorry I can't help, but sending good karma your way. 

Exactly. The bigger problem is the lady who weighed me said don't worry about taking off my shoes. Really upsetting that the entire situation was probably over clothing. I DID my job, and then some, to try and lose weight effectively. I DID *everything* they asked me to, and then some. 

Sigh.

But thank you for the positive energy. I do need that now. 

insurance companies are for profit companies. They are in business to.  Make a profit,not for our health and well being. 

Having said that,then,yes,I can certainly see them denying you for a half pound gain. 

As long as you continue to not meet their criteria,they will keep denying you,so they won't have to shell out money for a surgery. The more procedures they.  Deny,the more money goes into their shareholders pockets. That is the bottom. Line.

i can't see an appeal making them change their mine. All I can see is. For you to grit your teeth and meet those no gain requirements. 

I know if we could lose weight effectively,we wouldn't need Wls,but,unfortunately,it is what it is.

Thanks for the compassion and insight about the insurance industry. Without that I don't think I would have ever been aware of the situation.

That wasn't my question though. Let me reiterate - 

Anyone here have Aetna and have had them successfully approve the sleeve procedure? any advice while I sit and twiddle my thumbs waiting for them to respond to the appeal?

I would make a call to lindstrom obesity advocates. They return your call at most a day later and for a fee will join in the appeal process for you with a 90% overturn rate . The fee is very reasonable 

THANK you. Very much.

Good luck ! I hope you get your approval

You can do a search for Aetna approvals in the search box and see if you can get more specific help 

Aetna does not allow ANY weight gain during the 3 months supervised diet.  I was just approved and that was a major concern of mine during the 3 months.  Their policy reads as a "net" gain/loss.  I thought that meant that I just had to weigh less at the end of the 3 months than I did at the beginning.  Not the case though.  There can not be a gain at ANY weigh in.  I'm very sorry that the person weighing you didn't work with you to get rid of that .5 lbs.  Your shoes would have probably made the difference.