Question:
How large is the packet you submitted to your ins. for approval?
Yikes! I just counted the number of pages I've compiled to submit to my insurance and it's 50+ pages - that's WITHOUT my surgeon's information (I see him on Friday for a consult and to start the ball rolling with my insurance company). My Aetna HMO requires 5 year medical history and proof of 6 months Dr. supervised diet. I am also including my personal cover letter, list of co-morbidities, Weight Watchers documentation, exercise program enrollment papers, nutritonal guides, meal planning handouts and calorie counters I received from my doctors. Is this overkill?? I've read so many posts where people have been denied by Aetna for lack of information, or Aetna hs requested more information. I decided to hit them with both barrels. I'm curious, if your insurance company requires extra info., how large was the packet of info. you sent in?? Thanks! — Carly H. (posted on September 24, 2003)
September 23, 2003
My wife's surgeon - as well as my surgeon (who are both out of HUP) -
handled all of the stuff that was sent to the insurance company for
approval (we have Aetna). So I don't know how large the packet was. My
surgery was before the new guidelines. My wife's was after (initial
consult was 8 days after the guidelines changed) and we were afraid since
she hadn't had a dr. supervised diet over the past couple of years that she
would be denied, but she wasn't. However, she had been followed very
closely during that period because her diabetes was worsening, so this may
have helped her out...JR
— John Rushton
September 24, 2003
My packet was 70+ pages and I was approved in 4 or 5 days. Send everything
you have, and make sure it's in a organized fashion (I included a
mini-table of contents with mine. The more information they have, the
better!Mine included letters from 2 doctors, past hospital records, a huge
request letter detailing my comorbidities, past doctor visit records, a
letter from my husband, diet history, etc. etc.
— Tiffany J.
September 24, 2003
I work for a self insured insurance company. We typically get 40-50 pages
from the surgeon. You know what - we only need one piece of paper to
approve surgery. That is our criteria form. If everything is checked
"yes" and signed by the surgeon, that's all we need! No one here
has time to sift through all that stuff to see if the person meets
criteria, if the surgeon agrees that they meet our criteria. We don't
really want to see it unless there is a "no" checked on the form
and information is included to help get the surgery approved.
— koogy
September 24, 2003
Susan - Thanks for your input. I have wondered the same thing - who's got
time to look through all this stuff? HOWEVER, MY insurance company is the
one saying - We need your five year medical history and proof of a 6 month
Doctor supervised diet with nutritionist consultation and excercise
program, blah, blah, blah. My sugeon's office also has told me (when they
found out Aetna was my insurance)that on the intial consultaion I NEED to
bring in all the above documentation. So that's why I've been scurrying
like a squirrel gathering nuts to collect all this stuff. And, like I
said, I've sen countless posts from people on this site who say they've
been denied by Aetna who "requested more information" on
supervised diets, exercise and weight loss attempts, etc. Believe me,I'd
MUCH rather have a one page form that my surgeon could just check off the
facts. By the way, congratulations on your weight loss! Hope I can get to
a size 10-12!
— Carly H.
September 25, 2003
I sent about 50 + also ,I have Aetna they were a pain,I had to do 6mo with
a nutrinalist and also do execrices program,weight Watchers wouldn't work
for them .I also appealled every time my health got bad ,Like mu blood
pressure wasn't staple and I finally had a bone scan and it
showed damage to my left knee and arthist to my feet .they got the last
appeal on Aug.29 and they approved it on Sept.8
My surgery is Monday the 29th ,so as my sister said keep appealing every
little health problem you have.I also I started this last Jan. 2003 so it
did that some time.Good luck
— BRENDA B.
September 25, 2003
I have Aetna PPO. I sent them everything I could think of. This included 10
pg letter req WLS, diet history, family history, 5 letters (from obgyn,ear
nose and throat surgeon-for sinus surgery,cardiologist,sleep apnea Dr, and
PCP letter), notes showing I'va had sleep apnea for over 12 yrs and getting
worse, pictures and letter from WLS Dr. I just hope I get approved soon.
— bufordslipstick
September 26, 2003
P.S. I forgot to add that I sent in nutritionist consult letter,psych
letter, and 10 yr PCP history. My paperwork was about 1/3-1/2 inch thick. I
hope all of this helps me get approved. This time "with help from all
of my friends" was a lot easier to get together than the 1st time I
fought HMO by myself. I also wrote comments on my pictures as to where they
were taken, and pointed out things that were obesity related such as I had
to sit on "THE ONE BENCH" seat in the back of the dolphin cruise
boat because I couldn't fit in any of the other seats.
— bufordslipstick
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