Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 Well, I just thought I would post that I have been denied by Aetna USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & have lost 100lbs. My health is much improved, but I am not there yet. I am scheduled for my part 2 this Tuesday, August 21st--the denial is going for doctor to doctor review on Monday morning & then I will know if I will be having surgery on Tuesday. The timing is really stinky as I do have secondary insurance through Regence BC/BS, but there will probably not be enough time to submit to them in time for Tuesday. Neither policy that I have has wls exclusions & the companies only administer the plan--companies are self-insured. But, Aetna has changed their opinion of the bpd/ds states that it is unsafe. My complaint is, that when I was approved for my early May surgery they new that I was going to be needing part 2 in just a few months & were ageeable to it then. But, now that it is time--they can deny me a healthier life. I think I just needed to vent, I will not go away--I will fight to have part 2--only hoping that I won't have to fight beyond monday. thanks for listening(reading) take good care Ogretta post op part 1 pre-op part 2 dr inabnet mt sinai down 100+lbs & 5 sizes bmi 63 now 50 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 Well, I just thought I would post that I have been denied by Aetna USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & have lost 100lbs. My health is much improved, but I am not there yet. I am scheduled for my part 2 this Tuesday, August 21st--the denial is going for doctor to doctor review on Monday morning & then I will know if I will be having surgery on Tuesday. The timing is really stinky as I do have secondary insurance through Regence BC/BS, but there will probably not be enough time to submit to them in time for Tuesday. Neither policy that I have has wls exclusions & the companies only administer the plan--companies are self-insured. But, Aetna has changed their opinion of the bpd/ds states that it is unsafe. My complaint is, that when I was approved for my early May surgery they new that I was going to be needing part 2 in just a few months & were ageeable to it then. But, now that it is time--they can deny me a healthier life. I think I just needed to vent, I will not go away--I will fight to have part 2--only hoping that I won't have to fight beyond monday. thanks for listening(reading) take good care Ogretta post op part 1 pre-op part 2 dr inabnet mt sinai down 100+lbs & 5 sizes bmi 63 now 50 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 Ogretta, Is this 2 part procedure split up as gastrectomy and then bilopancreatic diversion? How strange to have them approve one part and deny the second. Maybe they think that since you have lost 100 lbs that you no longer need surgery. You suregon will need to explain that the gastrectomy will not produce permanant weight loss on its own because of the stomach will stretch. What was thier basis for denial? Hull > Well, I just thought I would post that I have been denied by Aetna > USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & > have lost 100lbs. My health is much improved, but I am not there yet. > > I am scheduled for my part 2 this Tuesday, August 21st--the denial is > going for doctor to doctor review on Monday morning & then I will > know if I will be having surgery on Tuesday. The timing is really > stinky as I do have secondary insurance through Regence BC/BS, but > there will probably not be enough time to submit to them in time for > Tuesday. Neither policy that I have has wls exclusions & the > companies only administer the plan--companies are self-insured. But, > Aetna has changed their opinion of the bpd/ds states that it is > unsafe. > > My complaint is, that when I was approved for my early May surgery > they new that I was going to be needing part 2 in just a few months & > were ageeable to it then. But, now that it is time--they can deny me > a healthier life. > > I think I just needed to vent, I will not go away--I will fight to > have part 2--only hoping that I won't have to fight beyond monday. > > thanks for listening(reading) > > take good care > > Ogretta > post op part 1 > pre-op part 2 > dr inabnet > mt sinai > down 100+lbs & 5 sizes > bmi 63 now 50 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 Ogretta, Is this 2 part procedure split up as gastrectomy and then bilopancreatic diversion? How strange to have them approve one part and deny the second. Maybe they think that since you have lost 100 lbs that you no longer need surgery. You suregon will need to explain that the gastrectomy will not produce permanant weight loss on its own because of the stomach will stretch. What was thier basis for denial? Hull > Well, I just thought I would post that I have been denied by Aetna > USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & > have lost 100lbs. My health is much improved, but I am not there yet. > > I am scheduled for my part 2 this Tuesday, August 21st--the denial is > going for doctor to doctor review on Monday morning & then I will > know if I will be having surgery on Tuesday. The timing is really > stinky as I do have secondary insurance through Regence BC/BS, but > there will probably not be enough time to submit to them in time for > Tuesday. Neither policy that I have has wls exclusions & the > companies only administer the plan--companies are self-insured. But, > Aetna has changed their opinion of the bpd/ds states that it is > unsafe. > > My complaint is, that when I was approved for my early May surgery > they new that I was going to be needing part 2 in just a few months & > were ageeable to it then. But, now that it is time--they can deny me > a healthier life. > > I think I just needed to vent, I will not go away--I will fight to > have part 2--only hoping that I won't have to fight beyond monday. > > thanks for listening(reading) > > take good care > > Ogretta > post op part 1 > pre-op part 2 > dr inabnet > mt sinai > down 100+lbs & 5 sizes > bmi 63 now 50 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 Ogretta, how very good to hear from you!!! I'm apalled that your insurance company is leaving you hanging at such a time as this! Of all the nerve.. I'll say a little prayer for you that all is quickly resolved. Congratulations on the 100lb weight loss, wawy to go!! Love, Meli - In duodenalswitch@y..., om55@c... wrote: > Well, I just thought I would post that I have been denied by Aetna > USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & > have lost 100lbs. My health is much improved, but I am not there yet. > > I am scheduled for my part 2 this Tuesday, August 21st--the denial is > going for doctor to doctor review on Monday morning & then I will > know if I will be having surgery on Tuesday. The timing is really > stinky as I do have secondary insurance through Regence BC/BS, but > there will probably not be enough time to submit to them in time for > Tuesday. Neither policy that I have has wls exclusions & the > companies only administer the plan--companies are self-insured. But, > Aetna has changed their opinion of the bpd/ds states that it is > unsafe. > > My complaint is, that when I was approved for my early May surgery > they new that I was going to be needing part 2 in just a few months & > were ageeable to it then. But, now that it is time--they can deny me > a healthier life. > > I think I just needed to vent, I will not go away--I will fight to > have part 2--only hoping that I won't have to fight beyond monday. > > thanks for listening(reading) > > take good care > > Ogretta > post op part 1 > pre-op part 2 > dr inabnet > mt sinai > down 100+lbs & 5 sizes > bmi 63 now 50 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 Ogretta, how very good to hear from you!!! I'm apalled that your insurance company is leaving you hanging at such a time as this! Of all the nerve.. I'll say a little prayer for you that all is quickly resolved. Congratulations on the 100lb weight loss, wawy to go!! Love, Meli - In duodenalswitch@y..., om55@c... wrote: > Well, I just thought I would post that I have been denied by Aetna > USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & > have lost 100lbs. My health is much improved, but I am not there yet. > > I am scheduled for my part 2 this Tuesday, August 21st--the denial is > going for doctor to doctor review on Monday morning & then I will > know if I will be having surgery on Tuesday. The timing is really > stinky as I do have secondary insurance through Regence BC/BS, but > there will probably not be enough time to submit to them in time for > Tuesday. Neither policy that I have has wls exclusions & the > companies only administer the plan--companies are self-insured. But, > Aetna has changed their opinion of the bpd/ds states that it is > unsafe. > > My complaint is, that when I was approved for my early May surgery > they new that I was going to be needing part 2 in just a few months & > were ageeable to it then. But, now that it is time--they can deny me > a healthier life. > > I think I just needed to vent, I will not go away--I will fight to > have part 2--only hoping that I won't have to fight beyond monday. > > thanks for listening(reading) > > take good care > > Ogretta > post op part 1 > pre-op part 2 > dr inabnet > mt sinai > down 100+lbs & 5 sizes > bmi 63 now 50 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 At 16:24 +0000 8/18/01, om55@... wrote: >Well, I just thought I would post that I have been denied by Aetna >USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & >have lost 100lbs. My health is much improved, but I am not there yet. > >I am scheduled for my part 2 this Tuesday, August 21st--the denial is >going for doctor to doctor review on Monday morning & then I will >know if I will be having surgery on Tuesday. If you don't mind sharing, what was their reason for denying you the 2nd part when they approved the first? --stella Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2001 Report Share Posted August 18, 2001 At 16:24 +0000 8/18/01, om55@... wrote: >Well, I just thought I would post that I have been denied by Aetna >USHealthcare for Part 2 of my bpd/ds. I had part 1 on may 4, 2001 & >have lost 100lbs. My health is much improved, but I am not there yet. > >I am scheduled for my part 2 this Tuesday, August 21st--the denial is >going for doctor to doctor review on Monday morning & then I will >know if I will be having surgery on Tuesday. If you don't mind sharing, what was their reason for denying you the 2nd part when they approved the first? --stella Quote Link to comment Share on other sites More sharing options...
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