discouraged!

trouble256
on 9/4/08 5:37 am - Athens, AL
so i had my consult with dr facundus a week ago, I had to turn in all the paper work they needed for my surgery to submit to Aetna.  I was actually reading through the guidelines and It requires me to have 2 years of recorded weight, 6 months of supervised diet, and 3 consecutive months of supervised diet.  CHECK-CHECK-CHECK!  so im all excited, well then they call me and say the need 5 years of medical history, so i went to drs and hospitals to find 2003, (my dr had moved out of town) so no records, they told me without this i would be denied.  I called aetna to find out what my requirements were.....same as listed above...why is the drs office doing this?? 

I mean I have given them loads of money!  And now they want to play all these games?  OMG, if I have to wait another year, so that I will have 5 years of recorded weight...Im going to scream! 

So to follow up I called and told them I spoke with the ppl at Aetna, and they mailed me the "guidelines" which I gave them info on how to find those online.  and they said, they would submit it but more than likely I will be denied.  WTF?!?!?! 

so now, all i do is sit and wait, Hoping for the best, expecting the worst.
Jamiee13
on 9/4/08 8:41 am - Henderson/Las Vegas , NV
I am sorry that you are going through this. I had to run around with my insurance to but luckliy they didn't require the medical history because I didn't have it. Hang in there!
trouble256
on 9/4/08 8:58 am - Athens, AL
you didnt have to have any medical history info?  wow, thats really amazing!  i dont think my insurance will be that nice.
Jamiee13
on 9/4/08 9:28 am - Henderson/Las Vegas , NV
Yeah When I first started looking into it I thought I had read I need a 5 yr weight history but when it was all said and done they said no I didn't which is great because I had been 2 the doctor 2 times maybe in 5 years ...
Shasta L.
on 9/5/08 1:36 am - CO
Is there anyone but your doctor who would have recorded your weight? for instance was your weight recorded by any weight loss programs you went through, any schools, ect. I have heard of other people not having access to medical records and finding creative ways to overcome it. For instance one person submitted pictures of herself during the year in question, and had a doctor who was willing submitt a letter stating there was no way she had gone down to a normal during that time. Don't give up. ask around this site, I know there are poeple on here who have found ways around this requirement.

Jennifer K.
on 9/5/08 4:15 am - Phoenix , AZ
Most insurance companies want 5 years of weight history - if Aetna is telling you they only need 2 years then your Drs office should be fine with that. Provide them with the sheet from Aetna stating that information. Either way the Drs office should submit to your insurance what you have no matter what.
Even if you get denied for not having enough recorded weight history there is an appeals process in place.
Also - if your Dr moved your records still have to be somewhere - by law most states require anywhere from 5 years (or longer) to be kept... check your state then follow up with the Dr/Hospital - some states never allowe records to be destroyed. More than likely if your last visit was 2003 the records are in storage and you will have to send a written request and it will take time (sometimes 6-8 weeks) for your records to be pulled (and you may have to pay, again depends on your state laws).
With insurance you are best giving them anything and everything you can to prove you have been obese for a period of time.

First visit to surgeon - 288 ~ bmi 45.1
2 week pre-op 252 ~ bmi 39.5
Total lost - 153 Since surgery - 117!
Goal weight - 155 (mine) 180 (surgeons)
Current weight - 135 (2020 I lost 10lbs due to dedicating myself to working out more and being in better shape)

1/14/2025 still maintaining 135 :-)

Extended TT, lipo, fat injections - 11/2011

BA/BL/Arm Lift - 7/2014

Scar revision on arms - 3/2015

HALO laser on arms/neck 9/2016

Thigh Lift 10/2020

Thigh Lift revision 10/2021

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