I just got a phone call that stated that I was officially denied for my lap band surgery (see previous post on here). First I was denied by Aetna then for appeal it goes to my employer  and they just decided to side with Aetna.

I have Buckeye community health plan as my secondary health insurance. If anyone on here has had any positive experiences with them-can you share them with me? I guess that will be my route.  I know that bariatric surgery will be the only way I lose my weight and be at a healthy weight.

I don't know what step to take from here. Feeling discouraged-been working with Aetna and jumping through their hoops since March of this year and per my PCP and the barix clinic I was going thru they said all my paperwork was 110% right. On to plan #2.

Thanks for any advice,
Angie

I tried to use my primary, she didn't do medically supervised diets. She then sent me to a dietician. Luckily I only went to her once before I found out this would not count either. I then called my surgeons office and they recommended a office that they work closely with. This office knew what documentation had to be completed and everything. I ended up a month behind, but I'm on track now and on my 5th month. At first I was very upset about having to wait for the surgery, now I love it. I've lost 40 pound so far, was able to research way more and be more informed about my decision, and I started lurking here and learning from those that have been through the trenches.

You must use your PCP.  Most insurances do not recognize any weight loss program other than one that is documented in your physician's notes for their 6 month medically supervised diet.  You go to your PCP, state you are there for weight loss and make sure the doctor is noting your weight, height, bmi in your office notes.  Also mine noted behavior modifications and documentation of following a low calorie diet and also noted my exercise regimen.
 I have Aetna and was denied at first for this exact reason....stating I did not have 6 months supervised diet.  I had 8 months of weigh****chers documented, but I knew this didn't count even though I was going weekly for 8 months.  My surgeon's office submitted my paperwork thinking WW counted since it was more than 6 months but Aetna denied.  I was just finishin up their  3 month multidisciplinary program which was all documented by my pcp and I filed an appeal and was then approved.

Bottom line...."m'edically supervised diet" means your physician.

Hope this helps...good luck to you

Nan

Karen- who is your insurer...  I am going through the same type of thing with aetna right now...

Id add to get a copy of the insurance criteria from the Aetna website.  If each criteria is met and they denied you may have legal recourse.  Hang in there I went through it 5 years ago but got my surgery and am still doing well.... its worth the fight :)