My Authorization finally came through!!! - ThinnerTimes

DonnaRae · 11-19-2007, 10:49 PM

HI all....I called my insurance today...and was told my surgery was approved...no questions asked (only took 10 days for my Aetna HMO - not bad from what I have been reading) I asked them to fax the authorization to me...and 2 minutes later it was in my hand. I called Dr. Callery's office...faxed it to them, and went in today for my pre-op...my surgery is scheduled for Tuesday, Nov 27th!!!!!!!!!!! So much more to be thankful for!!! I start the liquid diet tomorrow...and am so happy that I cannot stand it! It has been a whirlwind of a day. I will pick up all of my post-op meds tomorrow...and spend the next few days relaxing - or trying to - (and probably obsessing)...before my surgery.

I hope there is room on the loosers bench for me!

Toony · 11-19-2007, 10:58 PM

WHOOOHOOOOOO to YOUUUooOUOOUOOOoUUuuuUUU!

What exciting news! I have Aetna too --- they've had my paperwork since Nov. 3... now I think I need to call to check up on it!!!

Dr. Callery doesn't require 2 week liq. diet prior to surgery? I will have to do that here... no way things could ever happen that quickly for me!

katie

DonnaRae · 11-19-2007, 11:20 PM

I have actually lost 15 lbs in the past 2 weeks waiting for the approval...so he said just one week will be fine (originally wanted me to loose 26 lbs prior to surgery).

Thanks for the congrats.

My Aetna plan is an HMO plan...so the approval was issued by my IPA (primary provider group)...they were the ones I called...everyday...starting on the 3rd day after submission. The said it was submitted as a "standard" referral...and that it would take 7-10 business days. On the 7th day...they said Aentna did not cover...to which I threw a fit...as I had already called and was told they did. I then called Aetna...and was told it was a "blind assumed benefit - with legislation". What exactly that is...is that if it is NOT specifically stated in your benefits that it is covered (and it is NOT specifically excluded)...then if there is Legistlation in your state requiring coverage...then they are legally obligated to cover the surgery (Calif has such legislation - per Aetna). I called my IPA back...and left a message for the Medical director. I left him the name of the Patient Rep I spoke with at Aetna, and said to please contact them before a decision of "denial" as obviously they spoke with some "idiot" at Aetna. I received a call back last Thursday, stating they had received my message and the whole thing was under review. I called and left a "nice" message on Friday...and again this morning. I received a call back about 30 min later stating it was approved. I think I about jumped out of my skin. Said I did not want to wait for the mail...and to please fax...to my surprise...they did just that. That paper will probably get framed and hung up in my house!!! Sometimes...the squeeky wheels to get a little more attention...if not too "squeeky". The trick is understanding the insurance "junk". Having worked in an Ambulatory Surgery Center, running the Pre-op department for 8 years...taught me a lot about insurance...and just how far to "push" without totally pissing people off. (but of course, with my temper...I tend to cross the line on occassion)

By the way...I LOVE your cartoons! I look forward to seeing your replys...so I can see what you have drawn next!

Toony · 11-19-2007, 11:53 PM

LOL on the cartoons... I don't change them THAT often!

Interesting what each of us brings to TT... you with your experience pushing insurance guys around! LOL!

I seriously don't think this will happen for me until all the "i's" are dotted and "t's" are crossed... that'll put me into Jan.... with the pre-op diet, waiting on appts. with the "Nut" and the surgeon... I'm looking at Feb...

It's ok tho... I have changed my mind so many times on this whole adventure --- this'll give me more time to let things settle in - once and for all! As much as I complain about the wait, for me - it's actually a good thing... I'm a Libra... so I gotta make sure things are all balanced...

Nice to meet you Donna... I'll be thinking of you next week!!! Wheee!!!!

Katie