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Topic: RE: APPROVED
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
thanks so much....soon we both will be on the loser bench....yahoooo!!! lol 
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
Topic: APPROVED
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
IM SOOOO EXTREMELY EXCITED!! I WAS APPROVED FOR SURGER ON THURSDAY JULY 7, 2011!!!! IT TOOK 3 WEEKS TO HEAR BACK :) I GO ON TUESDAY JULY 19 TO GET MY DATE :)
It's true that we don't know what we've got until we lose it, but it's also true that we don't know what we've been missing until it arrives.
Topic: BCBSNC
I have a commercial policy with Blue Cross/Blue Shield of North Carolina. They have been denying anyone who wants a vertical sleeve gastrectomy, saying it is investigational.
I checked their site today and they have changed their policy!!
I really thought I was going to end up going to Mexico.
Finally, I'll get something back after all those premiums I've been paying!
I checked their site today and they have changed their policy!!
I really thought I was going to end up going to Mexico.
Finally, I'll get something back after all those premiums I've been paying!
Edie
Approved 8-1-11, Surgery 8-22-11 SW 231, Goal 140, CW 165
Topic: RE: How long for Aetna's insurance decision?
Angie,
Glad to be your friend too! Let me know when you hear from Aetna!!!!
I just read your blog on you profile where it gave the details of what you have been doing. It sounds like you have been doing everything right and what is expected of you!!!! The only thing that stuck out to me was that you started in March and submitted in June which is 3 months but was it 90 days apart?? From your first visit to your last vist has to be at least 90 days (180 if you are doing the 6 month program)
Just to be safe, if I were you, in case you already haven't, continue seeing your PCP so that you don't miss a visit during the approval process. That way, if they come back saying you did not complete the 3 mo MD program because you are xxx many days short, you will have your July visit in.
Just my thoughts......keep me posted on your approval!
Nan
Glad to be your friend too! Let me know when you hear from Aetna!!!!
I just read your blog on you profile where it gave the details of what you have been doing. It sounds like you have been doing everything right and what is expected of you!!!! The only thing that stuck out to me was that you started in March and submitted in June which is 3 months but was it 90 days apart?? From your first visit to your last vist has to be at least 90 days (180 if you are doing the 6 month program)
Just to be safe, if I were you, in case you already haven't, continue seeing your PCP so that you don't miss a visit during the approval process. That way, if they come back saying you did not complete the 3 mo MD program because you are xxx many days short, you will have your July visit in.
Just my thoughts......keep me posted on your approval!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: How long for Aetna's insurance decision?
Thanks so much for your reply - and your encourangement!! I am excited and scared, but mostly excited! I am so ready to live again - to be healthy and active!
It will be a week on Monday, so it is very early.
Sounds like you have a ton of experience with Aetna and you have obviously been a great success!! Congrats!!!
Glad to be your friend!!
Angie
It will be a week on Monday, so it is very early.
Sounds like you have a ton of experience with Aetna and you have obviously been a great success!! Congrats!!!
Glad to be your friend!!
Angie
Topic: RE: How long for Aetna's insurance decision?
Hi,
I have Aetna as well as my three children. All four of us have had bariatric surgery. Three of us did the 3 mo MD program and my one son did the 6 month program (only because he needed to buy time since he wasn't 18 yet) Two of us were denied at first and my two sons were approved right away.
With the approvals of my two sons, from the time it was submitted, it took about two weeks to hear back that they had been approved.
I was at first denied only because my paperwork was turned in too soon and I had not gone to my final physician visit. so as soon as I completed the program, I appealed and it took about 3 weeks for them to overturn the denial.
My daughter was also denied after going through the 3 month MD program. I filed an appeal for her, and it took 27 days to hear back that the denial was overturned and she had been approved.
A word of caution...don't be discouraged IF you are denied. I can help you with an appeal as I have had a lot of experience with Aetna and what the require with all four of us going through this. They are very picky about meeting the requirments, but as long as you have done everything required of you, they will approve.
Did you see your PCP, a dietician, document behavior modification and exercise with your PCP, meet the requirements of the BMI, and submit your psych eval? If so, you will have no trouble getting approved.
I had my surgery in March 2009, my daughter in May 2010, and my two sons in Dec 2010.
Good Luck to you!
Nan
I have Aetna as well as my three children. All four of us have had bariatric surgery. Three of us did the 3 mo MD program and my one son did the 6 month program (only because he needed to buy time since he wasn't 18 yet) Two of us were denied at first and my two sons were approved right away.
With the approvals of my two sons, from the time it was submitted, it took about two weeks to hear back that they had been approved.
I was at first denied only because my paperwork was turned in too soon and I had not gone to my final physician visit. so as soon as I completed the program, I appealed and it took about 3 weeks for them to overturn the denial.
My daughter was also denied after going through the 3 month MD program. I filed an appeal for her, and it took 27 days to hear back that the denial was overturned and she had been approved.
A word of caution...don't be discouraged IF you are denied. I can help you with an appeal as I have had a lot of experience with Aetna and what the require with all four of us going through this. They are very picky about meeting the requirments, but as long as you have done everything required of you, they will approve.
Did you see your PCP, a dietician, document behavior modification and exercise with your PCP, meet the requirements of the BMI, and submit your psych eval? If so, you will have no trouble getting approved.
I had my surgery in March 2009, my daughter in May 2010, and my two sons in Dec 2010.
Good Luck to you!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: Cash Pay
While I didn't have any complications to test it out, I was told that no complications would be covered. It made me wonder what could be tied as a complication and for how long, say 5 years down the road I have a hernia, will they try to blame it on this, etc. That was my biggest fear but to date hasn't been tested.
Topic: medicare medicaid plus pay aftercare self pay in cash preop?
I am medicare medicaid and they will cover R and Y by my understanding . I meet the doctor this week.
However, I was just talking to my neighbor who had medicare also but he had to pay Dr GastricBypasser $3000 upfront before he'd agree to operate ....not to leave a deposit on medicare or the like - but as a token of his sincerity about attending the aftercare program that is a support group, exercise, dietary ... yada yada. Which he'd have to pay anyway so said the doctor.
This set off warning flags in my mind. Is this reasonable to expect
However, I was just talking to my neighbor who had medicare also but he had to pay Dr GastricBypasser $3000 upfront before he'd agree to operate ....not to leave a deposit on medicare or the like - but as a token of his sincerity about attending the aftercare program that is a support group, exercise, dietary ... yada yada. Which he'd have to pay anyway so said the doctor.
This set off warning flags in my mind. Is this reasonable to expect
Topic: How long for Aetna's insurance decision?
I have Aetna.... Anyone have any idea how long it takes after submission for Aetna to make a decision?
AND I did the the 3 month "Fast Track" ... Anyone started with this and Aetna required them to go the extra 3 months?
If so, what was your final outcome?
Thanks so much in advance.
AND I did the the 3 month "Fast Track" ... Anyone started with this and Aetna required them to go the extra 3 months?
If so, what was your final outcome?
Thanks so much in advance.
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