jmh324

After 30 years of battling my weight I finally made the difficult decision to consult with a bariatric surgeon in March. My BMI is 40-41 and I just recently was diagnosed with sleep apnea. My insurance is Aetna and I went through the 3 month multidisciplinary program and did everything I was supposed to. My surgery was scheduled for today. Two weeks ago my doctor's office supposedly submitted everything but it took until last Wednesday for Aetna to confirm there was even a case pending. Friday morning they denied me based on the fact that although my BMI was 40 in 2007, it did drop down to 36 for a couple of months in 2008 when I was on a SEVERELY restricted anti-candida diet. They are saying I didn't have sleep apnea then so that disqualifies me. My doctor's point is that I just had not been diagnosed. In my doctor's notes from 2007 it very clearly states that I was having sleeping problems, but no one thought to test me for apnea. Anyway, since Friday morning they've been trying to set up a peer-to-peer phone call with Aetna. I'm not sure what the hold up is but every time I call they say they are waiting for the insurance guy to call back. My doctor's office said if they get the approval via the peer-to-peer (they intend to fight for me tooth and nail) they can reschedule me for Wednesday, but today was another wasted day. I'm not going to work tomorrow because I'm so stressed and do not feel like dealing with the "have you heard yet" questions. I am so upset and so disapppointed right now I just don't want to see or talk to anyone.

poet_kelly

Oh, I'm sorry you're having this trouble with your insurance company. Sometimes their rules can be so ridiculous. Hang in there, don't give up. Hopefully the peer-to-peer will work for you.

Kelly

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RNY 11/4/08

surgery/current/goal
270/147/130

mburgs

I'm so sorry to hear that! I hope you're able to get approved. I know exactly how you feel, it's been a long road for me and surgery got yanked out from under my feet a couple of months ago.

Keep us posted!

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Sherry_Lynn

Oh Gees, that is horrible. I would have fallen apart if that happened to me. It's such an emotional ride as it is. Call Aetna tomorrow morning first thing and request a Case Manager. Seriously, do it. Sometimes it's a matter of no one caring enough to look at all of the paper work. I will be thinking of you.

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Sherry Lynn

Proud Mom of two Saint Bernard Puppies, George & Gracie

Lap RNY





Highest/Day of Surgery/Current/Goal
336/303/229/180

jmh324

Thank you everyone. Apparently my doctor spoke with the insurance company last night so now we are just waiting for a decision. I'm trying to stay positive. I have to apologize for the double posting of the same thread!