Re: Aetna and July 12

June 13, 2000

Dear Donna,

Oh how wonderful to finally have a littermate, and to share anniversary

dates as well. Thank you for your kind words, it really does help. I

adored him so and he would have been a wonderful support for me while

going thru this. But I know he will be peeking over the clouds. Did

you want the surgery on your anniversary purposely? It will be just like

a new beginning so I think it's a great idea!

Now about my insurance; I do have Aetna U.S. Healthcare and it is an

HMO The letter Dr R sent to them utilizing the information I gave him

from the patient info form, seemed to have done the trick. Now it did

specifically say that any WLS was an exclusion, but I ignored that. I

think being morbidly obese { Oh don't you just love that line ? }

with a BMI of 51 helped as well. I do weigh 315 and I am only 5'4 " so

who knows maybe they figured it was life threatening. What I did do is

to call Aetna myself and I hooked up with the sweetest girl in Pre- Cert.

I told her I was not getting an answer and it was critical that I have

the surgery, about one week later after they found out Dr R was in

network, they approved me for surgery only. Then I had to do the dance

for them to cover the hospital so I called my new best friend in pre -

cert and sure enough 2 days later it was a go. I don't know for sure how

much she had to do with the decision, but I think she at least helped to

push things along. I will tell you tho that initially when I was

getting no where fast,and they played dumb, I did insist on speaking to

pre-cert and I was so upset I was crying from the frustration of it all,

and my contact person was totally sympathetic. The bottom line is, stay

on them everyday until you get your answer. Be tough but very sweet and

be clear what your needs are. BTW my pcp was getting the run around as

well so they said, but to be honest, I don't think they had the time it

takes to call and hold and all the time consuming stuff that is

necessary. So I would do most of the calling and call my pcp with

contact names. Ok keep me posted. I am always here for any help I can

give you. 32 days to go!!!!! Luv. Susie G. I hope it

is ok but I posted this on the list as well as to you just to help anyone

else along that I can :)

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