Aetna insurance?? Anyone?
Come Monday, I will have completed the 3 month required supervision requirement under my Dr.
that Aetna requires.
I get a call from the clinic from the lady that coordinates the insurance and she said that I have to prove that I had one other comorbidity since my BMI is 36.
Here are my issues
Primary Physician didn't support my surgery (although I sat on it for a year after my first seminar), she just tells me that my husband loves me the way I am....and her little skinny butt thinks that I should be ok with that.
On my LAST (and I do mean final) visit to her, she decided to address my HBPressure and put me on meds. So I have only been on the HBP medication for about 3 months now. (Really don't think I need it, as I am usually normal.....I just get worked up about having to go see her!) I have a new Dr. appt set up with new primary.
My sleep test showed that I did need a CPAP and I've been on it for about a month now, but Aetna mentioned that my AHI might of not been severe enough?? Didn't understand that?
I did have the Vein Closure procedure done in my legs this past summer for pain and fatigue in my legs.
I do regularly take gabapentin for neuropathy in my legs, (verdict still out on what has caused that, but I suspect weight!) Have been treated for leg pain for years.
Have documents from a Weigh Loss Clinic for the past 5 years, where I recieved appetite suppressants and " weightloss counseling".
My Question: The insurance lady told me to think of anything I could possibly think of to help send in to Aetna when they submit my case, because they are not wanting to approve. Who has experience with this that could offer some advice.
Thanks in advance!
that Aetna requires.
I get a call from the clinic from the lady that coordinates the insurance and she said that I have to prove that I had one other comorbidity since my BMI is 36.
Here are my issues
Primary Physician didn't support my surgery (although I sat on it for a year after my first seminar), she just tells me that my husband loves me the way I am....and her little skinny butt thinks that I should be ok with that.
On my LAST (and I do mean final) visit to her, she decided to address my HBPressure and put me on meds. So I have only been on the HBP medication for about 3 months now. (Really don't think I need it, as I am usually normal.....I just get worked up about having to go see her!) I have a new Dr. appt set up with new primary.
My sleep test showed that I did need a CPAP and I've been on it for about a month now, but Aetna mentioned that my AHI might of not been severe enough?? Didn't understand that?
I did have the Vein Closure procedure done in my legs this past summer for pain and fatigue in my legs.
I do regularly take gabapentin for neuropathy in my legs, (verdict still out on what has caused that, but I suspect weight!) Have been treated for leg pain for years.
Have documents from a Weigh Loss Clinic for the past 5 years, where I recieved appetite suppressants and " weightloss counseling".
My Question: The insurance lady told me to think of anything I could possibly think of to help send in to Aetna when they submit my case, because they are not wanting to approve. Who has experience with this that could offer some advice.
Thanks in advance!
For some reason, my surgeon's office tried to submit it too soon before the 90 days (because I am trying to get my surgery scheduled before the end of the year), they came back with the 90 day requirement plus the second comorbidity (which they already had sleep study in hand).
But I have only had HBP for a couple of months, and it is controlled with medication, does that matter?
Too, have you ever heard of the Sleep Apnea not being severe enough even though they put me on CPAP?
Thanks.
But I have only had HBP for a couple of months, and it is controlled with medication, does that matter?
Too, have you ever heard of the Sleep Apnea not being severe enough even though they put me on CPAP?
Thanks.
Sounds like the surgeon's office submitted before you finished your conservative weight loss. Yes they will deny. They won't take the promise that you will fini**** before surgery. I have heard some insurance company's say well it's controlled , your good, but I would fight that in an appeal. If you gain more weight it will be harder to control. If your on a CPAP that is saying you have sleep apnea.
Nancy
Nancy
Hey there... I have the same ins. but mine is HMO is yours? I was told by the ins co that I had to do 6 mos worth of visits to my PCP doc, a letter from them saying I need the surgery, 2 years worth of weights written down for them, a nut apt, a nutri apt and my PCP doc got me to do a sleep study which is next Friday. My BMI is 47 The two extra things you have should count!
It sounds like maybe they submitted your info to the ins co to soon.... I agree do an appeal what ever it takes don't give up! Good Luck...
It sounds like maybe they submitted your info to the ins co to soon.... I agree do an appeal what ever it takes don't give up! Good Luck...
I have Aetna POS, which is a High Deductible Plan, which is a good one. We put money into an account each month as if we were paying for our policy, then when the $2400 deductible is met, our part is 20%.
I've struggled so hard to maintain, as the Dr. has wanted me to. I have weighed the exact same for 2 months. So are you suggesting it might look better to put on a few pounds at my last appt? Like leave on my heavy jacket and not take off my shoes??? LOL
I do appreciate all of this helpful advice!
I've struggled so hard to maintain, as the Dr. has wanted me to. I have weighed the exact same for 2 months. So are you suggesting it might look better to put on a few pounds at my last appt? Like leave on my heavy jacket and not take off my shoes??? LOL
I do appreciate all of this helpful advice!
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