Gastric Bypass Surgery Support Group

Gastric bypass (GBP) is any of a group of similar operative procedures used to treat morbid obesity, a condition which arises from severe accumulation of excess weight in the form of fatty tissue, and the health problems ("co-morbidities") which result. If you are considering gastric bypass or have had it, join the community where we share our experiences and find support.

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Aetna Denied!!!

slimtbear
slimtbear
Hi everyone! I am new here. I have been seeing a nutritionist and jumped through a lot of hoops to get approved by my insurance (Aetna) for gastric bypass surgery. I am missing a weight from 2009 and I had a low BMI in 2010 (1st half). Of course, I had been dieting (DUH!!!) and then gained it back after my thyroid was removed. Sooo., long story short. Aetna is saying that I have not been fat long enough. I have weights going back to 2002 showing BMI above 40. Now what?? Surgeon did peer review today. They want a weight from 2009 and proof of a 6 month diet. I DON'T HAVE A WEIGHT FOR 2009!!!!!! I never let anyone take photos either. Unless people are standing in front of me. lol Anyway, any insight, encouragement, comiserating would be appreciated.

I was hoping to have the surgery by year end because my out of pocket is met. Writing a letter. Don't know what else to do. :(
deleted_user
deleted_user
No advice for you, except maybe ask the doctor if they won't approve you because of that amount of time, how long you will have to wait to get approved. I know for myself, my BMI was just below 40, but because of sleep apnea I qualified. But they told me I had to lose 15lbs before surgery. I was afraid if I lost 15lbs before surgery that my insurance wasn't going to cover me. But no problems in the end.
Judy-Anderson
Judy-Anderson
I was also scared to lose weight before surgery because i was just on the edge. I wish I could tell you something. I am sorry. I don't know how that works because I was up and down so much over the years myself , I don't get how they wont approve you on the weight you are . You would think they would approve you if you had other problems
deleted_user
deleted_user
did you see NO doctor in 2009? think back. no doctor for the flu, flu shot, physical, gyno (assuming you're female, lol you're name doesn't give it away) medication refill... nothing??? If you can't remember call the insurance company you had back then and tell them that you saw a doctor in 2009 and you are not sure who it was. They'll be able to access your billing records. It is well worth a shot. A whole year is a LONG time to go without seeing someone for something.
deleted_user
deleted_user
I have Aetna too. My doctor's office says these guys are one of the toughest. I didn't have a weight in 2009 either. I'm not sure how the doctor's office got around it. Any chance you participated in a managed weight program like Weight Watchers? I was told they'd take that as well. I was under my bariatrician's and nutritionist's care from April - October. They also made me go through 3 months of physical therapy, as an "exercise program". Yes, the 6 month wait was a hassle, but I think it was well worth it. Best Wishes!
Judy-Anderson
Judy-Anderson
good idea Susan! Any Dr. that year. Hoping you find one you went to that year!!!!!!
slimtbear
slimtbear
Thanks everyone. I was able to find a weight chart that I was doing myself. Do you think that would work? I mean I obviously didn't suddenly become obese if I have records from 2002, 2005, 2006, 2008, 2010, and 2011 that show my BMI above 40. Common sense thinking you would think. Anyway, going to talk to my surgeon today and see if we can be more persuasive.
deleted_user
deleted_user
You could "recreate" a diet and excersize log. Make sure to get the dates right. What about a drivers lic. photo or anything like that also. like others said any er visits or pt or doc visits anything?????
slimtbear
slimtbear
No Dr. visits anywhere in 2009. Must have been a good year :)
I gave my dr. the weights from my own log that I have kept up for the past 4 or 5 years weighing once a month. They are going to submit that with all of my weights going back to 2002 as well as all of my notes from the nut visits. We will see if that helps. I also wrote an appeal letter that they will be sending in as well. One thing I have to say, the Dr.'s assistant Sue has been wonderful! They are trying their best. Guess all I can do at this point is hope that Aetna has someone with a little good old fashioned common sense reviewing my file and I will hear "APPROVED" next week. Please keep your fingers, toes, etc crossed for me! Surgery is tentatively scheduled for 11/29. Desprately want this!
olandia64
olandia64
Seems like Aetna would realize they can approve it now or later. With costs going up all the time, less expensive to do it now. Saying a prayer for you.
deleted_user
deleted_user
If worse comes to worst, perhaps this experience has given you a new motivation and deteminatiion to make it work...if metabolism or sugar keeps you from being able to lose, there are meds the dr can give you. Look up VLCD very low calorie diet, and see if you can get supervision for 6 mos. This doesn't mean you can't lose weight...be open to the universe... also check the liquiddietdiscussionboard.com
May it be as it should be... rd {:>}
deleted_user
deleted_user
fingers crossed! {{{HUGS}}}
deleted_user
deleted_user
You might just have to start from the beginning. That's what I had to do. I had to see my PCP for six months with documentation from him. It ended up taking me nearly a year to get everything in order, but it was well worth the wait. Use this time to educate yourself as much as you can and remember there is a reason for everything. You're not meant to have the surgery yet. Rhonda
slimtbear
slimtbear
I have been at this since May....Definitely not trying to shortcut anything...Just not the most patient person in the world. It took me many years to arrive at this decision and now that I have, I just want to get on to the new me! If Aetna makes me wait until next year, then so be it, but they will pay for this in the end. I am determined!

As for other alternatives, I have done about everything out there short of hormone injections. I am no longer going to waste my time/money/hope on a diet that will not work for more than a year or so... Stay tuned!
deleted_user
deleted_user
I know how you feel, Best wishes for surgery this year.
Hang in there and keep head up. If it is ment to be it will happen!

(hugs)