ashleyw889

Denied...Again

Recommended Posts

Aetna denied my appeal. Now I look into getting a loan somewhere so I can pay for the surgery. Ugh!

Share this post


Link to post
Share on other sites

Why was it denied?

Kelly

Share this post


Link to post
Share on other sites

Did they tell you why? You can appeal again. I had to appeal twice before I was approved to see the doc.

Share this post


Link to post
Share on other sites

My BMI isn't over 40. It is currently 39.6. I don't have any co-mobidities. I do have arthritis, but I guess they didn't care. I did recently find out from my OB GYN that my glucose levels are high. I don't know why my surgeon didn't pick this up when they did all of their blood work. I need to make an appointment to see my PCP.

I could appeal again, but I'm so tired of waiting. It took a month to find out I was denied again. I'm so tired of being in pain (my knees).

Share this post


Link to post
Share on other sites

Some insurance companies will consider arthritis a comorbidity and some won't. I assume you submitted a letter from the doctor treating you for arthritis stating that losing weight would help the condition?

Without comobidities, they usually will not approve you if your BMI is under 40. Still, it seems it would be worth the effort to appeal again if you can. Also make sure you notify them that your blood glucose is high, although unless you are actually diabetic, they may not consider that a comorbidity either.

Kelly

Share this post


Link to post
Share on other sites

Yes, I submitted a letter from my doctor saying I had arthritis.

I guess I need to be more patient and wait to see if I have diabetes and then submit again. It is so hard waiting though!

Share this post


Link to post
Share on other sites

This may seem nit-picky, but how was the letter worded? Like, did it just say you have arthritis, or did it specifically say that your arthritis would likely improve a lot if you lost weight? And did it say things like, you would be less likely to need pain medications or cortisone injections or a knee replacement or whatever to treat the arthritis, if you lost weight? Because they may need to see how it helps their bottom line, you know? Pay for weight loss surgery, or pay for knee replacements for arthritis?

Kelly

Share this post


Link to post
Share on other sites

It was just a short letter that prescribed weight loss for my arthritis. I guess she didn't put too much time into it. :-)

Share this post


Link to post
Share on other sites

I'm sorry you were denied again, but don't give up the fight, that's what they want you to do!!!!

Share this post


Link to post
Share on other sites

Thank you John! No worries. I'm not giving up...not until I have the surgery. ;)

Share this post


Link to post
Share on other sites

Ok - everyone yell at me if you want but...

BMI of 39.6? Have some pizza and put on a few pounds.

If the insurance wants to play stupid games then you can also.

Share this post


Link to post
Share on other sites

With Aetna, by BMI has to be over 40 for two years. If I were to get it over 40, I would have to wait another two years. I don't want to wait that long. I have a two year old that I can't keep up with. I feel like I'm losing time. I need to get healthier so that keep up with him.

Share this post


Link to post
Share on other sites

I just got the cash price. Woohoo! It isn't as bad as I thought. $8,450.00. Now I just have to get a loan. Then I'm on to a date. :D

Share this post


Link to post
Share on other sites
I just got the cash price. Woohoo! It isn't as bad as I thought. $8,450.00. Now I just have to get a loan. Then I'm on to a date. :D

Does that include after care? If your insurance isn't going to cover the insurance they prob won't cover your after care. Make sure you are covered just incase something goes wrong. Good luck with getting the loan.

Share this post


Link to post
Share on other sites

Thank you! It covers any doctor visits up to 90 days after surgery.

Share this post


Link to post
Share on other sites
Thank you! It covers any doctor visits up to 90 days after surgery.

WOW that's a really good price!

Share this post


Link to post
Share on other sites

I would make double sure that price was correct, and included all the fees (surgeon, anesthesiologist, hospital stay, etc.). I am SO happy for you that you are going ahead with this, but that number seems REALLY low. I live in the south where things tend to be cheaper, and my surgery from beginning to end was $25,000.

Share this post


Link to post
Share on other sites

I'm in the south too. Well, I consider Houston, Texas the south. ;)

If I were to get it done at Herman Hospital in the Medical Center in Houston, it would have cost a little over 14,000. Since I'm getting it done outside of the Medical Center (Katy), it is cheaper.

I did ask him if it included surgeon and the anesthesiologist. He said it did. It doesn't include hospital because my surgeon told me it is outpatient surgery. I realize I will be responsible for any charges if I do have to stay over night, but I'm willing to take the risk.

I need to get healthier for me, my son, and my husband.

Share this post


Link to post
Share on other sites

RNY outpatient? Really? Ashley, that would scare me.

I know you can go to Mexico for pretty cheap...a lot of doctors are highly recommended. I didnt look into it because of the complications my mom had--i wanted to stay close to home, just in case....

I would not even consider doing this outpatient.

Share this post


Link to post
Share on other sites

Go to your insurance company web site and read what they require. Make sure you have done their requirements. Mine required 6 mos doctor supervised diet! They just didnt say so, once I completed it, I got approved for WLS. Pain in your knees & pre diabetic are good reasons. Each insurance company has their own requirements.

dont give up

Share this post


Link to post
Share on other sites

Out patient ! No way, run dont walk away! do not use anyone that does WLS outside of a hospital

Share this post


Link to post
Share on other sites

Isn't RNY Gastric Bypass? I'm not getting that. I'm getting the lap band.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now