Oh No!!!

Almost as soon as I got to work today, my phone rang. I saw my surgeon's number and my stomach immediately started fluttering. I thought, "This is it - yes or no." NOT!!!

The nurse did not send in the records for 2012 (I think they threw them out because I only had two office visits in 2012 and they were both just under 40 BMI at 39.7). Well, of course Aetna wants them. Now I'm scared because I was in the middle of a divorce and the stress caused me to lose a few pounds and I was also on a doctor supervised diet. Aetna says they want you to have tried diets and have not been able to keep the weight off but mine just happened to be right in the middle of when I need documented weight.  

Aetna is a stickler for a BMI of 40 and if they don't approve because of this, I'm looking at 2015 before I can have surgery. Self pay and/or a loan is not an option at this time. Yikes!

Hang in there.  Surgeon's offices will help you with an appeal.  They want to be able to do the surgery just as much as you want it done.

Jane

Thanks. I know but I'm not liking the extra waiting. My office wants me to have it within a certain time frame due to some of our deadlines so I need to have this fixed fast. Of course, I would rather not have to go through the appeal process.

This would not be a follow up call to your doctor's office.  If I were you I would make a personal trip to that office to get a copy of those records.  One, to ensure they get mailed off to Atena and two, at least you will have a copy on hand to mail in yourself if they fail to do so.   

Good Luck and prayers.

Thank you. I had a copy myself so I resent it to the nurse. She is pretty good at being on top of things. I'm just hoping Aetna doesn't say no. Fingers are crossed and lots of prayers being said right now. :-)

I promise you they didn't throw any records away from 2012 - that would be illegal in most every state.  Doctor's offices are required to follow state laws when it comes to medical record retention.  Most states require keeping them 5-7 years after the last date of service.   Push your doctor's office to locate and provide those. 

I'm sorry, I wasn't clear. My primary doctor already sent a copy to both my surgeon and myself. I don't think the surgeon kept anything in my file they weren't using because she told me today that they hadn't received those records but I received a duplicate package of what was sent to them. I have re-faxed everything to my surgeon but I'm just nervous for the 2012 weights because Aetna is very picky about them.

I'm willing to bet that you will be ok.  You said in your comment,"they want you to have tried diets and not keep the weight off".  That's pretty much what happened, right?

Good luck, and keep us updated. I hope you get good news soon!

Thank you.

If you work for a large company/corporation, I'd suggest you have someone in your HR or benefits department call the insurance company.  They just may have some influence on them re timing of approval...no promises, but considering your company chooses to buy their insurance, it might help.  just a suggestion.

good luck!
Sophie