vickie B.
Meanwhile back at the farm...............
Aug 31, 2007
Leah, the insurance coordinator at Dr. Stewart's office, received my medical records from ob/gyn #1 - she found weight logs in excess of 40 BMI for 1997 & 1998
- YAY! I'm just waiting on 
Kim (the wonderful nurse assigned to my case) to call me back to let me know what the decision is for surgery - I'm nervous/excited to finally be getting somewhere!!
- YAY! I'm just waiting on Kim (the wonderful nurse assigned to my case) to call me back to let me know what the decision is for surgery - I'm nervous/excited to finally be getting somewhere!!
Update re: peer to peer
Aug 25, 2007
Okay - called Aetna after peer to peer review to find out they are upholding the decision to deny. I spoke with the nurse assigned to my case and she told me I still had 14 days to provide additional info before having to go into appeals. She also told me what I needed to do. It seems the medical advisor that reviewed my case is one of the more lenient ones and indicated she would approve me if I could find records showing two more years where my BMI is above 40. So I got on the horn and am having my OB/GYNs send my records from 1997-2000 - somewhere in there it is going to give the info I need to get approved!
Carry on.....
Carry on.....
Denied - but wait - there is hope!
Aug 22, 2007
Well- Aetna denied me saying "it isn't medically neccessary". Yeah, okay, whatever! It seems that my BMI fell below the magic number of 40 for a couple of years. Well of course it did, I was taking Adipex stacked with Meridia - you're going to lose weight when you're strung out on speed! 
Could they not read the info and deduce from said info the reason weight was lost is because this woman was on 2 kinds of stimulants AT THE SAME TIME? AAARRRRGGGGHHHH!!!!! Anyhow, I cried, then I called Leah at Dr. Stewart's office. She was mad because she thought Aetna had called me. I explained that I had called them. She told me she already knew and was setting up a peer to peer review with the Dr. that denied me. Leah told me not to worry, that she submits to Aetna 3-4 times per week, and the exact same thing happens about once a month - lucky me! She went on to say that Dr. Stewart ALWAYS gets the denial overturned. Anyhow, I am just waiting for the review and Leah's call telling me I'm APPROVED! Then we can schedule a date with the doctor!
Could they not read the info and deduce from said info the reason weight was lost is because this woman was on 2 kinds of stimulants AT THE SAME TIME? AAARRRRGGGGHHHH!!!!! Anyhow, I cried, then I called Leah at Dr. Stewart's office. She was mad because she thought Aetna had called me. I explained that I had called them. She told me she already knew and was setting up a peer to peer review with the Dr. that denied me. Leah told me not to worry, that she submits to Aetna 3-4 times per week, and the exact same thing happens about once a month - lucky me! She went on to say that Dr. Stewart ALWAYS gets the denial overturned. Anyhow, I am just waiting for the review and Leah's call telling me I'm APPROVED! Then we can schedule a date with the doctor!
About Me
Corinth, TX
Location
33.8
BMI
Surgery
02/04/2008
Surgery Date
May 05, 2007
Member Since
