Introduction/Newbie Here!

ocbreeze4u · 06-21-2008, 06:45 PM

Hello! My name is Dawn, 39 years old and I live in sunny Southern California. After initially seeing the doctor for Lap Band in January 2008 then going through 2 appeals I FINALLY received news yesterday via mail that Aetna over turned their decision and granted me the approval for Lap Band with Dr. Naim.

They will be setting my appointment on Monday for sometime in late July 2008 so I am very excited. I am currently 222 lbs. with a BMI of 37 and my goal weight is 125...no, I am not being unreasonable as I was 125 8 years ago when I was 31 so this is not a high school weight I am throwing out there

I wish all of you luck and I would also like to know of others that live here in California to do some online bonding with.

Dawn
Corona, CA
height 5' 5"
current weight 222
goal weight 125
Currently approved by Aetna and waiting to schedule surger for July 2008 with Dr. Naim with Top Surgeons in Beverly Hills, CA

slinkymalinky · 06-21-2008, 07:36 PM

Hi Dawn,
I'm new here too - waiting for an initial consultation on July 8th, but because the clinic I'm at is very new (i'm in Manitoba, Canada), I'm hoping to be banded by mid-August! Like you I'm 222lbs, but I'm only 5'4, so my BMI is a little bit more! Not sure what my goal weight is yet - I think I'll know it when I get there! If you want to keep in touch that would be great, as it seems we have a similar journey, and are starting it around the same time.
Take care,
tracey

serenity55 · 06-21-2008, 07:46 PM

Hi Dawn,

Congratulations on getting approved!

There is a support forum for local groups, and under the one that says USA, there is one for California.

I live in Van Nuys, and am having trouble with insurance, because I don’t have receipts proving that I’ve tried different kinds of weight loss procedures.

Good luck to you, and welcome to LBT!

Bananalee · 06-21-2008, 07:49 PM

Congratulations on your approval! How exciting :) Can I ask why you were turned down twice? I am just starting on my journey and have not even had a consultation yet so I'm excited to hear others' stories.

-Brittany

ocbreeze4u · 06-21-2008, 11:11 PM

The reasons I was denied by Aetna...

Aetna's criteria is that you must have a BMI of at least 35> persistant for the last two years. About a year ago my weight went down to 204 which lowered my BMI to 34.7...if I were just one pound more at 205 I would have been at 35 BMI. I missed it by one pound!

The second time Aetna denied me was due to my doctor then entered my height as 5' 7" weighing 222 lbs, I am 5'5 so again...in the last two years my BMI dropped below 35 lbs.

In both cases my doctor did a peer to peer review with Aetna and in the end he prevailed and I won!!! Just for the record, I am with Aetna PPO Choice. I do know that Aetna HMO does not cover this surgery.

Thank you to all of you for your kind words of encouragement.

Dawn

madss · 06-22-2008, 05:24 PM

Hi,
I'm Madeleine, I'm in Hollywood. I'm getting banded on Wednesday the 25th.
madeleine

melallot · 06-22-2008, 09:58 PM

Hi Dawn, I live in Apple Valley and also going with Top Surgeons and I also have Aetna and my surgery is July 11th. lets keep in touch to trade stories pre/post op, k?
Mel