Re: Aetna folks...any updates? , Spencyr, Sandy K., Randy P., etc...

[Guest guest]

is under the knife as wee speak and should be in post op any

time now!

> > > > > NO ONE has ever been approved for DS by Aetna????????????

> > > > > Sandy K.

> > > > > In insurance Hell

> > > > > Aetna US Healthcare PPO

> > > >

> > > >

> > > >Sandy K,

> > > >

> > > > When I wrote the following message to , I was referring

> to

> > the

> > > >several messages I've seen on this site and elsewhere, that

> prior

> > to

> > > >August 2000, Aetna PPO DID approve a few DS surgeries, but

> revised

> > > >their coverage to exclude DS after that date.

> > > > After I have my inital consult I suspect I'll be in

insurance

> > hell

> > > >right along beside you.

> > > >

> > > >Jennie/KY

> > > >Aetna PPO

> > > >

> > > >

> > > ><<<,

> > > > I'm probably going to have the same problem re: Aetna

> approving

> > > >RNY, but not DS because they NOW consider it investigational--

> what

> > a

> > > >crock. I'm planning to fight for a BPD/DS--that is if I have

the

> > > >strength (I'm praying) to hold out while they dangle a RNY

> approval

> > > >in front of me like candy. I think it's going to take a lot of

> > very

> > > >vocal, visible and persistant proponants of DS getting in their

> > face

> > > >before they will reconsider and approve it once again. You

> > > >know, " the loudest voice gets heard, " and all that stuff. If

> just

> > > >one person gets approved for DS, surely, this will open the

door

> > for

> > > >others to follow. Just my opinion...

> > > > Best of luck with whichever way you choose to go. I hope

> > you'll

> > > >keep us posted. --- Jennie/KY >>>

> > > >

> > > >

> > > >

> > > > >-----------------

> > > > >From: Randy Peck <peckfam@t...>

> > > > >>Subject: Re: Re: Aetna Insurance Question...

> > > >

> > > > >Vickie,

> > > > >I to am waiting on Aetna approval. I have Aetna POS. Dr

Welker

> > has

> > > > >sent my letter of medical need. I know of a few Aetna

approvals

> > > > > Gold, Laurie N(8-27-99), Mac (who has unfortunately

> passed

> > > > >away). There are a few >more, if you go to obesity .com and

> look

> > > > >under insures and check each state you can find them. Hope

this

> > > > >helps let's keep the faith. Randy P -

> > > >

> > > >

> > > >

> > > >

> > > >---- Original Message -----

> > > >From: " Vickie H. " vickie.hewitt@b...

> > > >To: duodenalswitchegroups

> > > >Sent: Thursday, October 19, 2000 12:35 AM

> > > >Subject: Re: Aetna Insurance Question...

> > > >

> > > >

> > > > > Hi ,

> > > > > I just got back home from NYC. (three hr drive, each way) I

> > know of

> > > > > four people

> > > > > who have Aetna and are waiting, you are one of them, as am

I,

> > > >Spencyr

> > > > > is the third and the fourth. They did approve a DS

> surgey

> > for

> > > > > Christa last July. But I don't know the code.

> > > > > I would expect that Spencyr will hear first as her surgery

is

> > > > > scheduled for early November.

> > > > > I will keep you posted if I hear anything.

> > > > > Vickie H.

[Guest guest]

is under the knife as we speak! She should be in post op any

time now

> > > > > NO ONE has ever been approved for DS by Aetna????????????

> > > > > Sandy K.

> > > > > In insurance Hell

> > > > > Aetna US Healthcare PPO

> > > >

> > > >

> > > >Sandy K,

> > > >

> > > > When I wrote the following message to , I was referring

> to

> > the

> > > >several messages I've seen on this site and elsewhere, that

> prior

> > to

> > > >August 2000, Aetna PPO DID approve a few DS surgeries, but

> revised

> > > >their coverage to exclude DS after that date.

> > > > After I have my inital consult I suspect I'll be in

insurance

> > hell

> > > >right along beside you.

> > > >

> > > >Jennie/KY

> > > >Aetna PPO

> > > >

> > > >

> > > ><<<,

> > > > I'm probably going to have the same problem re: Aetna

> approving

> > > >RNY, but not DS because they NOW consider it investigational--

> what

> > a

> > > >crock. I'm planning to fight for a BPD/DS--that is if I have

the

> > > >strength (I'm praying) to hold out while they dangle a RNY

> approval

> > > >in front of me like candy. I think it's going to take a lot of

> > very

> > > >vocal, visible and persistant proponants of DS getting in their

> > face

> > > >before they will reconsider and approve it once again. You

> > > >know, " the loudest voice gets heard, " and all that stuff. If

> just

> > > >one person gets approved for DS, surely, this will open the

door

> > for

> > > >others to follow. Just my opinion...

> > > > Best of luck with whichever way you choose to go. I hope

> > you'll

> > > >keep us posted. --- Jennie/KY >>>

> > > >

> > > >

> > > >

> > > > >-----------------

> > > > >From: Randy Peck <peckfam@t...>

> > > > >>Subject: Re: Re: Aetna Insurance Question...

> > > >

> > > > >Vickie,

> > > > >I to am waiting on Aetna approval. I have Aetna POS. Dr

Welker

> > has

> > > > >sent my letter of medical need. I know of a few Aetna

approvals

> > > > > Gold, Laurie N(8-27-99), Mac (who has unfortunately

> passed

> > > > >away). There are a few >more, if you go to obesity .com and

> look

> > > > >under insures and check each state you can find them. Hope

this

> > > > >helps let's keep the faith. Randy P -

> > > >

> > > >

> > > >

> > > >

> > > >---- Original Message -----

> > > >From: " Vickie H. " vickie.hewitt@b...

> > > >To: duodenalswitchegroups

> > > >Sent: Thursday, October 19, 2000 12:35 AM

> > > >Subject: Re: Aetna Insurance Question...

> > > >

> > > >

> > > > > Hi ,

> > > > > I just got back home from NYC. (three hr drive, each way) I

> > know of

> > > > > four people

> > > > > who have Aetna and are waiting, you are one of them, as am

I,

> > > >Spencyr

> > > > > is the third and the fourth. They did approve a DS

> surgey

> > for

> > > > > Christa last July. But I don't know the code.

> > > > > I would expect that Spencyr will hear first as her surgery

is

> > > > > scheduled for early November.

> > > > > I will keep you posted if I hear anything.

> > > > > Vickie H.

[Guest guest]

> > It was way back in Oct. when the following thread was posted. I

> > was just wondering if there are any updates. Anyone else been

> > approved, and how you did it? Anyone been denied, and what your

>

> > going to do about it?

On October 13, more than three weeks after submission of the LOMN, I

was denied because BPD/DS was " investigational. " I went ahead and

self-paid on 11/8. Dr. Gagner has agreed to help me with the medical

aspects of my appeal letter, and of course if it is successful I'll

make it available to anyone who needs it. (I hope he's reviewing it

as I write.) The main argument I made was that if Aetna covered it in

the past and continues to cover it some of the time, it is

inequitable to assert that it is " investigational " in my case. I gave

surgery dates for past approved Aetna patients. I listed the

companies that I know cover BPD/DS. I also pointed out what I thinkis

a major medical error in the August 2000 coverage bulletin, and said

that in light of the failure of the bulletin to cite several recent

scholarly articles on BPD/DS, the " investigational " claim was without

basis. As soon as Dr. Gagner gets back to me, I'll send it in.

Deborah

[Guest guest]

,

Glad to hear your your doing so good. Good to hear was able to

have her surgery too. Hope she does great.

Jennie

> is under the knife as we speak! She should be in post op any

> time now