Jackofcubs

Hey guys. 26yo, Male patient pre-op!

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HI everyone!

 

My name is Cody. I am 26, live in East Texas, and am scheduled for surgery in October. Well, assuming my insurance company doesn't throw us any curve balls. We were able to give my insurance company all requirements except 1 :/ 

 

3 years of weight history. Sounds easy right? Call your doc, get some faxes, donezo. But that isn't possible on this one as my Primary Care Physician for the last several years lost his license.... And then promptly shut off his phone and fax.

 

Hah. So anyway, I sent in 2.25 years worth of Withings Smart Scale readings, and random weigh ins here and there. You'd think pictures should count too since I've been a big guy all of my life lol...

 

Anyway. Anyone else had any issues with the weight history requirement?

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Welcome to TT Cody! 

This forum is a good one. I like it here and I hope you do too. Congats on your date and I wish you luck with the final approval!

 

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Thank you :D This place has been great for a lot fo the questions I had before making the decision to follow through with the vertical sleeve.

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Welcome!

I didn't have the weight history cause I rarely went to the doctor (not my fault I'm never sick!).  So what my primary doc did was write a letter stating I was fat in (whatever year she saw me) and I am even fatter now (when she saw me again) so stands to reason I've been fat all inbetween there.   Clearly it was worded better, but that is the gist.   That's all it took, insurance except thated.

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My insurance company (Aetna) required 2 year history which I couldn't show. They denied the first time and denied the peer-to-peer but approved when I submitted a written appeal. I referenced the clinical practice guidelines for bariatric surgery that were published in 2013 which says nothing about patients needing to have a multi-year history of obesity. If you get denied, let me know and I'll email you a copy of the appeal letter I submitted to my insurance company. 

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Howdy and welcome!

Every insurance company is different, but there is always an appeal process if they say no.

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Yes , I had to have three years of proven weight attempts but stay big but my doctor had my records and faxed them fourteen years of them . I hope you have enough records and I wish you the best on your new life journey .

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Welcome to T-T Cody!

Can't help with the weight history.  I had my WLS through a military facility - my primary care was done there so I guess they had that record to go by.

Hope you get it sorted out soon.

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Welcome Cody, great to have you here.  The weight loss history can be met several ways; it doesn't always have to be a trend in medical charts.  Like Jolls my PCP just wrote a letter and it was more than enough.  I wouldn't worry about it unless it becomes a real problem.

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sup, dude? welcome to TT.

as everyone else has said, you'll get the weight loss requirement figured out soon enough. all the pre-op processes are there for a reason, and if you get denied, it's never - EEEVER - a final say. trust me. i write appeals for a living. if you run into any issues, please let us know!

my brother bariatricbro should be chiming in soon... he's only a year older than you, and is a future fellow sleever, as well. :)

again, welcome!

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Welcome

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Hi New Here :) 

Aetna PPO 2 year weight history-

So i went to my first consult i provided medical chart records dates in 2008 and 2012; I may have trouble finding a weight record for 2013. I saw my PCP last in 2012 and took a medical wellness screening in 2014 which recorded my weight, Im going to ask my PCP to write a letter based off everyones post. I feel a bit better; after finding the wellness screening BUT

Does anyone have a sample letter for my PCP to write. 

Thank you for any and all help guys

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I hope all goes well.  I just submitted my weight history and all the other requirements today.  I'm waiting for my insurance approval.  So hopefully we both will get good news.  I understand how you're feeling.  I'm so nervous.

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HI everyone!

 

My name is Cody. I am 26, live in East Texas, and am scheduled for surgery in October.

Looks like other people have answered your insurance question. Given her successful appeal to the same insurance company as you have, I'd make note of Dunndeal's user name in case you get denied for lack of weight history. Hopefully your PCP losing his license won't pose a problem for you.

Your mention of East Texas for my attention, but I had to look up where Jacksonville is. Seems to be kind of in the middle of nowhere. I grew up in Dallas and went to school for a couple of years in Nacogdoches but never took Hwy 175 farther south/east than Athens. 

WOW. I was composing this reply when I jumped up, dropped my phone, and broke it. That was last Thursday. Just got back to it today, after my phone was repaired, and what I'd said so far was still there. But I digress...

Anyway, welcome!

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I hope all goes well.  I just submitted my weight history and all the other requirements today.  I'm waiting for my insurance approval.  So hopefully we both will get good news.  I understand how you're feeling.  I'm so nervous.

good luck!!!!! It will all be okay. It makes me feel better reading all the post about persistence and finding a way! I'll keep my fingers crossed for you!!!!!!! Keep us updated 

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Yo Bro! What's up! TheColdestAugust said I would arrive and I have! FISTBUMP!

But, in all seriousness, congrats on making this awesome step toward being healthy, especially at a young age. Tackling something like this in your 20s is a great thing to do. If you ever have kids, nieces, nephews--whatever it may be, you want to be around long enough to enjoy them and keep up with them!

As a data guy, the Withings was a smart idea and should hold steady if an appeal is necessary. If an appeal happens to be necessary, which hopefully it won't, just keep trucking like you've been approved and practice what your Bariatric center has given you. It'll be for the best.

If you ever want to chat, you can hit me up on here or via email at Bariatricbro@gmail.com. 

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I was approved today!! The nurse called and set my surgery date for Oct. 20th.  I couldn't believe have fast Aetna responded.  I thought it would take much longer and that they would ask for more documents. 

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Yo Bro! What's up! TheColdestAugust said I would arrive and I have! FISTBUMP!

But, in all seriousness, congrats on making this awesome step toward being healthy, especially at a young age. Tackling something like this in your 20s is a great thing to do. If you ever have kids, nieces, nephews--whatever it may be, you want to be around long enough to enjoy them and keep up with them!

As a data guy, the Withings was a smart idea and should hold steady if an appeal is necessary. If an appeal happens to be necessary, which hopefully it won't, just keep trucking like you've been approved and practice what your Bariatric center has given you. It'll be for the best.

If you ever want to chat, you can hit me up on here or via email at Bariatricbro@gmail.com. 

Thanks man. That means a lot to me, and being a data guy myself I was very happy I kept those records with the withings scale hahahah. I keep numbers in my head allllll day since I do data analytics for a medical company! :D

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Thanks man. That means a lot to me, and being a data guy myself I was very happy I kept those records with the withings scale hahahah. I keep numbers in my head allllll day since I do data analytics for a medical company! :D

Ha, I do Data Science for a large retailer here in MN. Have to use the data to get the weight off! 

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Insurance approved! WOOOT!

 

Now to wait for the clinic to call and schedule me in :D

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Congrats Jackofcubs!  That's great news.  Let us know when you schedule your surgery date.

Insurance approved! WOOOT!

 

Now to wait for the clinic to call and schedule me in :D

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Surgery date scheduled. 10-26!

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