Frustrated, Frustrated, FRUSTRAAAATTTTTEEEEDDDDD!!!!!!!!! Anyone else dealing with...

So, I got my lap band in 2009 and had nothing but problems.  At that time I had United Healthcare.  My husbands job switched over to Aetna last summer.  In January they approved me to have my lap band out.  So, on January 4, 2013 my lap band was taken out.  We then submitted a preauthorization request for the VSG.  In February they denied it and sent a letter stating that I needed to have 3 month of supervised nutrition visits.  At that time I had one so I did my next one in February and the final one on March 13, 2013.  On March 15, 2013 Aetna received all additional follow-up information.  I have been getting the run around from everyone that I speak too at Aetna about how long it takes to approve, someone else stated that it was also denied, the next person said it wasn't and that my surgeon's office would have to request a peer-to-peer review.  I have had the hardest time getting ahold of the girl at the office so today I called and she wasn't there so another lady who doesn't do revisions asked if she could help me.  I went through my story and she called Aetna.  They told her that it was denies because I never even qualified for the lapband in 2009!!!!!!!!!!!!!!!!!!!!!  Say what???????????????  I doubt United Healthcare would have approved or paid for it if I did not qualify.  My BMI was > 40.  I didn't have any co-morbidities at the time however now I am having significant pain in my knees which I know is related to my weight and the need to lose it.  First, I don't know why they have a right to say anything at all regardless since they were not my provider at that time and secondly on my BMI alone I qualify without any co-morbidities.  I am so frustrated and just want to scream.  I feel defeated and I just want to give up at this point.  I have had to fight for everything my entire life and this is just taking everything out of me.  Especially because I can't even get a hold of the girl at my surgeon's office.  I am just so frustrated.  I am wondering what others would do in this situation.  Any advice??

No advice but I totally feel for you! My husband is getting a major run around by Aetna too. April 1 his company switches to BCBS so we plan to try w/ them!

Thank you.  I just don't understand.  I never had any issues with United Healthcare and all the information on the Aetna website is so vague. 

I got it with no problem with Aetna - but was super morbidly obese - don't know if that mattered or not or if they changed up in the past 2 years.

Now I did recently have to fight with them to get an MRI with contrast approved when I had an abnormal MRI - took about 3 months.  Their review company is a hot mess!

Good luck!

Thank you. My husband said that when he gets home in the morning we are goingto look at doctors in Mexico and if they do a final denial after the peer to peer then we are headed to Mexico.

No advice but having the same with Federal Blue Cross....  They approved my band removal but denied my sleeve revision.  They keep saying I did'nt do my nut/diet but I did.  Did'nt go to weigh****chers or anything but went to the Nut.  So now the dr is trying to set up a peer to peer.  BTW lost 80ish pounds and kept it off, with the band.  No where near where I would like to be, but....  I am only having the removal because of multiple slips, and extreme pain off and on, and the diabetes raising its ugly head again. 

Good luck, and fight!  Dr says they want you to go away and go to Mexico!

Wow, unbelievable.  You are right though....they do want me to go away and go to Mexico.  I am just so irritated that they approved the lap band removal knowing it was because of complications and that I was still morbidly obese and then don't think that I would want to continue on this journey.  I think I am going to try and find something that talks about the % of lap band failures.  It makes it even worse when I would have loved to be successful with the band.....if it didn't give me so many complications.  Oh well, I guess fighting on is all we can do!!!

Good luck to you as well.  Let me know what happens!!!  I'm curious.  :)

I'm sorry your having so much problems with Aetna.  I have had no problems with Aetna.  They do require the 3 months of office visits and weigh in with your PCP.  Your lap band has nothing to do with Aetna other then them knowing your history.  You should call Aetna directly and talk to them.  Good luck.

I agree that Aetna has nothing to do with my band...that is just what the lady at provider services said to my doctor's office yesterday.  It doesn't make sense.  I have called Aetna every day repeatedly.  Trying to get someone who will help.  I call precert and they say that since it was "denied" (because I needed to complete nut visits) that it was sent to provider services and I should speak with member services and when I go to member services they say that I need precert and then they both end up saying that it is with provider services and only my physician office can speak to them.......grrrrrrr!!!!!!  What a joke!!!!!!

call and ask to speak to a supervisor. the under staff are trained to give you the runaround. Get the supervisors full name and position title and tell him/her you know what your rights are. Tell him/her that you know that insurance policy wording has to be clearly written so the average person can understand it. This IS true by law. Tell them you want them to send you the EXACT requirements and if they can;t send you EXACT requirements because the wording is too vague,then you DEMAND that this person approve you immediately,like while you are on the phone with them and send you immediate email confirmation .

 

This info was given to me by Lindstrom obesity advocacy. they are out of CA but work all over the us. It would be worth your time and money to contact them,esp if you are prepared to go to MX,use some of what you would use to self pay to MAKE the ins co do the right thing by you. often just a phone call from Lindstrom scares the ins co enough to make them approve you.

 

I dont work for this agency nor do I get any kickback from them at all. i just know ,from checking into them myself when I was denied for an exclusion on my policy that they have helped many thousands.

 

GL