Disappointed: need advice

Thread Starter  

Had initial consult with nurse coordinator at surgeon's office. She stated she didn't think Aetna would approve me since bmi has only been 40 this yr and no serious comorbidities. Last couple yrs bmi has been between 38-39. My cholesterol is borderline high and I have knee tendonitis weight is a contributing factor. Nurse didn't want me to waste any out of pocket money in case Aetna disapproves. So should I not try getting LAP-BAND^® approval or ignore her advice

I would see with your insurance company. See what they have to say. I would have been denied for insurance to cover it because I am perfectly health besides being over weight and I am young. So I would surely say, talk with your insurance company and give them a hypathetical synario and see if you get positive feed back. The band is worth every penny. Had I not been in this teen study I am in, i would have told my parents to sell my car and pay for it out of pocket.

good luck!

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Banded 10/03/2007 :]
Dr. Santiago Horgan
Ucsd Medical Center
San Diego, CA

Good luck all and keep up the good work!

Hollie

I would contact the insurance company myself to ask what their requirements are. Sometines, the requirements are controlled by the company (employer) providing the insurance. It can't hurt to check. Good luck!

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Banded 09/25/08

I agree ask aetna. However, brace yourself; the NP is probably right. She's most likely seen it and doesn't want you to waste any funds (very nice of her!)

__________________

PCM 7/3/08 Seminar 7/10/08
Upper Gi, Psych,Nutrition, Surgeon 7/25
Tricare Approved 7/31
1st surgery 8/11 fatty liver no band
Banded 8/29/08!!! BY:
Dr. Sonny Cavazos, Texas Bariatric

SD. I have Aetna I'm based in CT. Aetna is covering my surgery 90% I just had to call and ask if it was covered. They told me I had to be part of a 6 mos supervised diet with a RD (reg. Dietican) and attened an exercise program. Good Luck :biggrin2:

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Heather



Started my journey in June 2008
New Birthdate 11-18-2008
Day of Surgery Weight 262 /Goal 150

12/18 First Fill; 4CC

But Heather, what was your BMI and did/do you have any comorbidities?

__________________

PCM 7/3/08 Seminar 7/10/08
Upper Gi, Psych,Nutrition, Surgeon 7/25
Tricare Approved 7/31
1st surgery 8/11 fatty liver no band
Banded 8/29/08!!! BY:
Dr. Sonny Cavazos, Texas Bariatric

My doctor told me i didn't have enough info for them to submit and that i need to wait and do the 6 month diet i insisted that the submit it anyways and one week later - I was approved and that was monday and i am having my surgery covered 100% by Aetna in Las Vegas. don't give up!

Restless My BMI is 39 an I have to loose 10lbs on my own before we can even begin the two week OPTI-FAST A thon!! I had no co-morbid to start with..... However since my surgical consult I found out that I have Moderate Sleep Apnea (who knew I always slept well). No High Cholesteroil, No type 2 Diabeites, No High Blood Pressure just over weight I'm 260 now and need to be 250 before I can get a date.

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Heather



Started my journey in June 2008
New Birthdate 11-18-2008
Day of Surgery Weight 262 /Goal 150

12/18 First Fill; 4CC

Thread Starter  

slim-n-tn, where in TN are you being banded. I live in Memphis.

Heather that's great news for the OP (and for you!) :)
She definitely should be on the phone to Aetna first thing tomorrow morning! :)

__________________

PCM 7/3/08 Seminar 7/10/08
Upper Gi, Psych,Nutrition, Surgeon 7/25
Tricare Approved 7/31
1st surgery 8/11 fatty liver no band
Banded 8/29/08!!! BY:
Dr. Sonny Cavazos, Texas Bariatric

I would try to see what the insurance company says. You never know. If they do approve congrats to you. I myself am and out of pocketer paying for the whole procedure myself! Yikes! But thankfully my parents are helping out, but I am just worrying about how I will pay later. I just know that this is the right thing to do. If your insurance company doesn't pay for it I would try and see if you could get a loan from the bank. That is always and option. Or you could see if there are any finance options from your surgeon. With all the money you are saving on not over eatting you could always put that money towards the payments. Good luck and keep up posted!

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Cassie


Start Weight: 270
Surgery Date: October 9, 2008
Dr. Salimaitari - Beverly Hills, CA
"Nothing tastes as good as skinny feels"