Recent Posts

dawneb
on 11/8/10 7:53 am - Pacific, WA
Topic: Peer to Peer, succesful!!!!
Hi all,  I saw my surgeon today and we discussed him doing a peer to peer with the medical director at CIGNA.  He didn't think that it would make a difference but promised he would fight for me.  Guess what!  Success!!!  I'm still in shock!  Guess he had to go through every visit with him since band was placed in 2007 and stress the reasons over and over again as to why I'm having intolerance issues with the band.  Got my approval!!  Scheduled for sleeve surgery on December 8th.  i love Dr. Srikanth!!!
        
mrsconrad
on 11/8/10 5:58 am - Steger, IL
Topic: RE: 6 month diet/gained weight!?
My Aetna nurse case manager did indicate that my weight gain may have been a factor in my first appeal denial, so I went for one more month and showed a small loss overall, and then was approved on second appeal.  However, this was just the opinion of the nurse case manager.  Also - please make sure that your six month program was a full six month- not just six visits, that seemed to stall me as well!

Good luck!
        
mrsconrad
on 11/8/10 4:05 am - Steger, IL
Topic: FINALLY!!! APPROVED!!!! THANK YOU!
Hi all-

Good news, I am finally approved on second appeal.

Like many - I used Nan's letters, stuck to the specific details on what they were asking for and used all available sources to gather info for the appeal.

I hope to have a date later this week.

Thank you all for all of your support!

Maria
        
Nan2008
on 11/8/10 12:49 am - Midland, MI
Topic: RE: Medical Spending Account

When my daughter had her RNY surgery last May it was covered by insurance, but we had to pay $1,880 out of pocket.  I turned that into my FSA (Flexible Spending Account) and it was covered. 

Nan

Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
help77584
on 11/8/10 12:37 am - Pearland, TX
Topic: RE: DENIED BY AETNA ON APPEAL
Hi Rosie,

Would you mind sending me the letters that you have drafted?  I am concerned because I have to a 5 year weight history and my weight history hasn't always been with a BMI of 35 so I need all the help I can get to get the insurance company to approve.  I'm trying to do surgery prior to the end of the year so I need a quick approval.  Thanks!  My email address is [email protected]
    
Little_Toto
on 11/8/10 12:12 am
Topic: RE: Anyone know of a Complications Insurance Co.?
Google information about Blis Insurance Company.
SW/CW/GW   224/140/135
5'2"  no pre-op diet
       
            
Little_Toto
on 11/8/10 12:04 am
Topic: Medical Spending Account
Hi.  I still have money in my medical spending account that I'd like to use or lose by the end of the year.  My insurance is not covering my VSG so I am self paying.  Question - can I make a claim against my medical spending account?

Let me know if y'all know.

Thank you!!
SW/CW/GW   224/140/135
5'2"  no pre-op diet
       
            
Nan2008
on 11/7/10 11:49 pm - Midland, MI
Topic: RE: I FOUGHT for an approval..and GOT IT!!

CONGRATULATIONS!!!   I am happy for you!

I couldn't agree more when you say 'no one wants it more than me'.  That is how it was for me as I put together my own appeal and also my daughters and won both with Aetna also.  You have to take it into your own hands and fight hard for yourself because no one is going to fight a hard as you want it!

Both of my sons were just recently approved and they are having surgery December 13th!!

Good Luck to you and Congratulations again!

Nan

 

Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
kimberly_gr
on 11/7/10 5:46 am
Topic: RE: I FOUGHT for an approval..and GOT IT!!
Glad it finally went through for you.  I had read your prior postings and couldn't understand why you were denied.

Congratulations!
Kim
5'0"
"In two decades I've lost a total of 789 pounds. I should be hanging from a charm bracelet."  Erma Bombeck
  
J. gale
on 11/7/10 1:04 am - Liberty, NC
Topic: RE: Denied by Cigna
Just keep working towards it. I had finished the 6 month program with my doctor but the insurance company did not like the way it was documented.  I restarted a new 6 month program and got 3 months into the program, when I got the call that the insurance company had reconsidered and approved it.
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