Kristen H.

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We found out what is going on. Semantics! Language!! Today we resubmitted to Aetna. Instead of requesting "pre-authorization" which apparently means to Aetna, "Pay for this even thought you usually don't", we used "pre-certification" language which means "Pay for this because you usually do if the patient meets the established criteria."

Today I had to admit my father into the hospital, via the Baker Act, for a variety of health problems. At least this way he'll get stabilized. My mother just couldn't do it, and my brother is in California. I know that God doesn't give you more than you can handle, but sometimes I wish that he didn't have so much faith in me.

DENIED FOR THE FIFTH TIME!!?? I called Kelley and told her that since the firm had screwed up the appeal, she needed to sort this out. I have everything that Aetna requires for surgery. What is going on? I am so ready to use my 401k for this, but I feel so guilty. I don't want to do that to my family but Daniel assures me that we could make it up in a year.

Dr. Kim's office resubmitted me for the RNY today. I learned that I was being denied because the Lap-Band is such a new procedure. I have even more documentation this go around - added obstructive sleep apnea, plantar faciitis in both feet, and GERD.

Denied! For the fourth time. Kelley called today. She started out by saying, "Kristen, I fall on my sword." Hmmm. Not a good way to start a phone conversation with your lawyer. Apparently someone in their office completely missed the fact that I have already done a first appeal. So they sent in my second appeal under the first appeal's time line. So Aetna denied me just because the darned thing was late! My God, what if this was the packet that made the difference and I was going to be approved?

Dr. Kim's office is going to resubmit me (a whole new package) for the RNY as opposed to Lap-Band. I had changed my mind re: surgery type anyway, because of my current diet. With the Lap-Band, I could possibly continue to eat/drink the same calorie-laden food and still gain weight - even with the band! Melted ice cream goes through the band, so does 22 ounce flavored creamers with 2 ounces of coffee. You get the idea. It is the best option for me, and my family (even Daniel!!) supports it!

Today my second appeal sent to Aetna by Kelley Lindstrom. I sent Kelley a two inch thick set of documents related to my case. She said that she had never seen such a thorough packet! That made my day. I just think that, although I am paying them, I need to do everything possible to make it easier for them to secure my approval.

Frustrated yes, angry, yes. A pushover? NO!! I just hired Walter and Kelley Lindstrom from the Obesity Law and Advocacy Center in San Diego. Walter has had the RNY before, and they have excellent success rates (particularly with Aetna). FYI, they have a web site at http://www.obesitylaw.com.

Denied! For the third time. I am so frustrated.

Today I sent in my first appeal, which is laboriously crafted myself. I think that it is pretty darned good, actually. Lots of documentation and references to medical journal articles. Fingers are crossed!

Denied! For the second time.