Denied - not my fault!!!!

The insurance person (won't mention her name) from Dr. Juarez's office did a HORRIBLE job sending my info to Aetna, and I was denied just two days after they received info. So I have to send the appeal, she doesn't do that. Thing is, Aetna has everything they need! She won't call them and tell them that though. She didn't even try or anything for me. ANd even told me "I didn't send everything you gave me because you gave me too much." Can you believe it?????? I was denied because Aetna said I don't have 6 months of dr supervised weight loss. NOT TRUE!!! I have been undergoing dr supervised weight loss since July 2004. Thing is, that dr is in the same office as my primary care doctor, so his records are interspersed with my primary care doctor records. She did not separate my diet records from my medical records to show dr supervised weight loss visits to his office for six months. They also said I was denied because medical records didn't show I have been morbidly obese for 5+ years. YES I HAVE! So she is going to send me my records back from Dr. Juarez office and I have to submit everything to Aetna MYSELF to appeal their denial. Trust me, I'll get approved becuase I'll separate EVERYTHING and label EVERYTHING with what they are looking for so it's easy to approve. I'm so mad at the insuranace person at Dr. Juarez's office. When I talked to her today I told her that I gave EVERYTHING to her that Aetna needed. The dr supervised weight loss and 5 years of medical records, and she said yeah, I know. I asked if she even bothered to tell AEtna they already have all the info they say they don't have. She said no. Aetna left a message for her and she just called me. She didn't call Aetna back. ISN"T THAT HORRIBLE????? All she has to do is call Aetna back and say, "Trisha's dr supervised records are in with her primary care doctor records. They are in the same office so the ones that "Brennan" wrote were weight loss visits. And see dates XX, XX, XX, XX, XX in medical records to show 5 years of morbid obesity." But no, she won't even do that!!!! How can she get away with this?! I though for SURE I would get approved. This is insane!! I did everything I needed to do to get approved, and because this person didn't organize my info clearly, I'm denied. Aetna has EVERYTHING they need to approve me. This is insane! Asking for prayers for peace and calmness about this whole matter. I wasn't too upset today at work when I talked to her, but as time has gone on, I am getting more and more upset!

Keep your chin up, Trisha. Sometimes it takes quite some time to knock down the beaurocratic walls enough to get surgery covered. If it's any comfort, everyone I know who has been denied, has eventually been covered when they stick it out and keep fighting the original decision. It might not hurt to get a lawyer in on it. That tends to speed things up. - Stephanie J

Be sure and tell the DR. what happened w/his staff, he's losing business and money because of her, not to mention good repore w/his patients. He would want to know.

trish ialso had aetna..they denied me the first time but two weeks later they approved it..i also had dr fang in dr juarezes office do my surgery,,call aetna yourself and they will send you a denial reply form write a letter how the wls would better your quality of life ..BE VERY DESCRIPTIVE....and send it in yourself..good luck..feel free to call me or email me my number is 928-726-4816......ron....

Don't give up Trisha! Keep us update! God Bless, Sandy