worried

I was so excited that I got through the 4 month program Aetna requires prior to approval for RNY. I find out today they denied and we have to appeal. I had finally got excited that it was going to happen and now it isn't looking good. How do you manage the worry while waiting?

I'm sorry that I can't be of any help. I was lucky in that my insurance had to pre requirements for me. 

I will say that I hope your appeal goes QUICKLY, and you are able to get your surgery. I wish you all the best. 

Oh, I don't know what to tell you about that worry while you wait on an appeal. That just stinks. Why did they deny? I have to do the 6 month weight management program before we can submit for approval with my insurance and this is my biggest fear...that they will deny me. I will die if they do that to me. I already told a close friend that I would probably finance it myself and do it anyway. I got to do this. I am so sorry and I wish you the best with your appeal!

I am not sure why they denied. They were scheduling a dr to dr call with aetna and they asked if I was compliant with my band. They said they may need to request my previous surgeons notes to see if I was complaint.

I really hope this works out for you. 

Reading your post and your follow-up reply, I am wondering if it was officially "denied," or is it rather in a holding pattern?  Does it require an official appeal, or just a follow-up with your doctor?

We also have Aetna insurance.  For several procedures for my family in the past few years (like MRI's not related to WLS), our doctor has had to get on the phone with them for them to approve. Usually after he has discussed things with him, everything has gone smoothly.

Regarding WLS through Aetna, after I submitted everything, thinking everything was taken care of for the submission, I found out they would not approve because of one small, kind-of-buried requirement.  Once I did that thing, they approved quickly.  So, although I was not technically denied, I did experience the extra attention to detail that the Aetna underwriters carry out.  I appreciate that they just have to do their jobs, but the waiting and worrying was so hard.

I hope that is what is happening for you, and that it all works out quickly.  

That may be the case. My liasion said they denied and they are appealing. She said they will continue until all requests and possibilities are exhausted. I just cant see getting this close and then not being able to do it. Thanks for all the stories. Makes me feel there may be hope still.

Most are denied on the first submittle.  Don't get down yet. It's a dance that the doctors and the insurance companies do. If your BMI is high enough and a few comorbidities thrown in. You will get approved.