rainbowconnection
OMG Can it be true
Jul 23, 2008
I am approved. I found out yesterday I am approved. I have Aetna PPO Choice Plus through HISD. I never thought this would happen for me. I am beside myself. When I found out yesterday I cried. I would guess it's like tyring to get pregnant for a long time and then it finally takes. I haven't posted in awhile bc I guess I really was trying not to think about the process bc I was so afraid of being denied. January-went to Dr. Davis' seminar and late in the month had an appoitment with him. I was told I had to go on the weight management program at Methodist Hospital (which was covered by Aetna) as part of my pre-op requirements from Aetna. February to June17- I did my monthly appointments and monthly seminars. (Seminars- I found them to be very interesting. First one was on sleep apnea and metabolism, Second was on dermatology non-surgical for after surgery, Tonights is on sex/tantric, food and god.) Each appointment you discuss how you are doing on the diet. There is also a meeting after that you discuss a topic-what is a portion, nutrition-who what when where and why you eat after the surgery (extremely informative and helpful, a complete play by play), and how to deal with life and emotions without the crutch of food. WM program then sent my file and report back to Dr. Davis' office. It includes all their notes, food diaries, stomach test results (breath test to rule out ulcers or cancer, etc), attendance in each class and at least one seminar. Then the bariatric coordiantor sent my complete file to Aetna. I had an approval back in a week. I got an email today from the surgery scheduler that she is looking to put me on late August.
So now I am waiting to hear from the surgery scheduler for my surgery date and the finacial secretary for how much money I have to pay out of pocket.
So now I am waiting to hear from the surgery scheduler for my surgery date and the finacial secretary for how much money I have to pay out of pocket.
New Year New Try
Jan 23, 2008
Well last year I tried to get approved through my husband's insurance through Neweigh but turned out his policy had a specific exclusion. Darn!! I was very saddened when I read my last post at the excitement and desperation I felt. Hopefully this post will have more success!!
So, my husband calls me in October of 2007 and tells me he just got an email saying they were going to add some new bariatric coverage to his Aetna policy when it renewed January 1, 2008. Whew who!!
My husband calls Aetna in December to find out what the new coverage is and they tell him they won't know until the first when it becomes effective. So we wait ...
January 7, 2008. My husband calls Aetna to get the scoop on the coverage. They will pay but only 4 doctors are approved in Houston. I call two of them but they are retired!?! I call the other two doctors who are father and son and in the same practice. I tell the receptionist I want to make sure they wil take this new Aetna coverage and she puts me to their insurance specialist, Margie, and I leave a message. She calls me back and I explain what Aetna said and she tells me she will call Aetna and call me back
January 16, 2008. Margie calls and confirms the coverage. The coverage is up to $10,000 at 50%. So if the surgery was $20, 000 Aetna would pay $10,000, if the surgery was $12,000 Aetna would pay $6,000, if the surgery were $25,000 Aetna would pay $10,000. So basically Aetna is saying we will help you pay for part of it but you have to pay for half or more of it. So, I accept this and sign up for the weight management seminar at Methodist Hospital. It is the first step.
January 21, 2008. I go to the seminar and Dr. Garth Davis explains all the types of surgeries past and present and what's good and bad about each and risks and compications. He answers questions, even though in my opinion most people could have found out their answers on the web before the seminar or should wait and speak to his office or him later bc the questions were to personal or specific. Anyway the seminar was good and informative.
January 23, 2008. I call and make and appointment to see Dr. G. Davis February 20th. I am excited but afraid more. It's hard having to wait and see. Once I meet with the doctor they will start the approval process and then I will know how much my out of pocket will be. According to Aetna's calculator on their website the by-pass surgery should be about $18,500. So my out of pocket would be $9,000 and that is doable. My husband and I have been working to save the money for the surgery. We even sold one of cars last year in order to save more money. At worst we would have to wait until the end of the year bc we would need time to save up enough money. At best we will have the money by June which I would think would be the earliest I would be scheduled for surgery. I still have to go through the approval process and presurgery processes, etc. Nothing is ever certain in this game.Sometimes I get frustrated and think why am I wasting my money or I don't want to wait or why don't I just go back on WeightWatchers and keep my money. I have been a lifetime Weightwatchers participant since I was around 10. I used to go to kids WeightWatchers but I don't even know if that still exists. It is definitely a good program and is really the only one I am successful at bc it accomodates your good and bad days. My problem is I can't stick with it more than six months. At that point I fall off the wagon and it is impossible for me to get back on for at least another six months. I always look at it as a way to maintain my weight. The forty to fifty pounds I lose when I am on program I gain back when I am off program so I figure at least I didn't gain those pounds in addition to what I already weighed!! Defintiely a fat girl's reasoning, lol! So anyways here we are facing the dream again. If I understand everything I have been told and presented then I am in a good position to move forward. I just keep worrying that the cost will be more than what Aetna has agreed to pay and the providers are will to accept. It's just time to hurry up and wait ....
So, my husband calls me in October of 2007 and tells me he just got an email saying they were going to add some new bariatric coverage to his Aetna policy when it renewed January 1, 2008. Whew who!!
My husband calls Aetna in December to find out what the new coverage is and they tell him they won't know until the first when it becomes effective. So we wait ...
January 7, 2008. My husband calls Aetna to get the scoop on the coverage. They will pay but only 4 doctors are approved in Houston. I call two of them but they are retired!?! I call the other two doctors who are father and son and in the same practice. I tell the receptionist I want to make sure they wil take this new Aetna coverage and she puts me to their insurance specialist, Margie, and I leave a message. She calls me back and I explain what Aetna said and she tells me she will call Aetna and call me back
January 16, 2008. Margie calls and confirms the coverage. The coverage is up to $10,000 at 50%. So if the surgery was $20, 000 Aetna would pay $10,000, if the surgery was $12,000 Aetna would pay $6,000, if the surgery were $25,000 Aetna would pay $10,000. So basically Aetna is saying we will help you pay for part of it but you have to pay for half or more of it. So, I accept this and sign up for the weight management seminar at Methodist Hospital. It is the first step.
January 21, 2008. I go to the seminar and Dr. Garth Davis explains all the types of surgeries past and present and what's good and bad about each and risks and compications. He answers questions, even though in my opinion most people could have found out their answers on the web before the seminar or should wait and speak to his office or him later bc the questions were to personal or specific. Anyway the seminar was good and informative.
January 23, 2008. I call and make and appointment to see Dr. G. Davis February 20th. I am excited but afraid more. It's hard having to wait and see. Once I meet with the doctor they will start the approval process and then I will know how much my out of pocket will be. According to Aetna's calculator on their website the by-pass surgery should be about $18,500. So my out of pocket would be $9,000 and that is doable. My husband and I have been working to save the money for the surgery. We even sold one of cars last year in order to save more money. At worst we would have to wait until the end of the year bc we would need time to save up enough money. At best we will have the money by June which I would think would be the earliest I would be scheduled for surgery. I still have to go through the approval process and presurgery processes, etc. Nothing is ever certain in this game.Sometimes I get frustrated and think why am I wasting my money or I don't want to wait or why don't I just go back on WeightWatchers and keep my money. I have been a lifetime Weightwatchers participant since I was around 10. I used to go to kids WeightWatchers but I don't even know if that still exists. It is definitely a good program and is really the only one I am successful at bc it accomodates your good and bad days. My problem is I can't stick with it more than six months. At that point I fall off the wagon and it is impossible for me to get back on for at least another six months. I always look at it as a way to maintain my weight. The forty to fifty pounds I lose when I am on program I gain back when I am off program so I figure at least I didn't gain those pounds in addition to what I already weighed!! Defintiely a fat girl's reasoning, lol! So anyways here we are facing the dream again. If I understand everything I have been told and presented then I am in a good position to move forward. I just keep worrying that the cost will be more than what Aetna has agreed to pay and the providers are will to accept. It's just time to hurry up and wait ....
In the beginning
Nov 20, 2006
I started the process today. I went to NeWeigh and did a complete medical history. I am so excited but apprehensive. I have tried before with other doctors and have been denied. I did some research on the internet and found NeWeigh which really works the appeals process. They submit your surgery for approval and then automatically submit up to 3 appeals after that. Joe, my medical history advisor told me I have a good chance of being approved bc I have United Healthcare. She also said that UHC usually responds within a week. I want this surgery so bad but am trying not to get too excited bc the reality is that insurance companies don't want to pay for it. I have my next visit on Wednesday to meet the doctor and watch videos on different types of surgery. Wish Me Luck!!!!
