Wife denied surgery by our insurance carrier

After weeks of weekly weigh -ins and specialty Dr's visits in hope of getting approved for surgery,
my wife was told this past Friday that her request for surgery was denied.

She wasn't given any other explanation by our HMO Dr., and was given a referal to a Bariatric Dr. instead. My question is, how does the appeal process work? and, has anybody had any success with Aetna/Lakeside Medical Group with regards to approvals?

My wife is 5'-8' 285lbs and has sleep apnea, high blood pressure and occaisional heart arythmias. Wouldn't these things be considered co-morbidities and make her a good candidate for surgery? 

I'm really trying to understand the logic of this whole process, especially in light of my wife's life long battle with her weight ,and the healing and control that surgery would bring her.


 

I am sorry to hear that your wife was denied. BUT DON'T GIVE UP!! Keep putting in those appeals, because  your wife would qualify even without the co-morbidity's. I was the exact same size and height but without any co-morbidity's, and I got approved after my first appeal. I wish your wife the best of luck, and keep us updated on what happens!

You can contact Walter at Obesity Law. Here is the website: http://www.obesitylaw.com/lawyers.php

And contact page:
http://www.obesitylaw.com/contact.php

Good luck to you and your wife.

Don't give up!!!!  My Dr. submitted my paperwork 4 times and I was denied 4 times.  But then the 5th time was the charm.  Just keep doing the weekly weigh-ins and keep trying.