RE: AETNA HAS DENIED MY APPEAL

Hello Everyone: First of all I want to wish each and everyone of yall a very safe and happy holidays and may God continue to bless you in this journey. Aetna has denied my appeal due to the fact that I did not have the full 6 months diet physician-supervised nutrition and exercise program. Even though I have gone on several diets and a member of a wellness club and have exercised, they still denied me since they did not think that was enough or supervised by the PCP. I am pissed off with my PCP since I told her and the PA that is what is stipulated in the policy and the fact I did not push the issue with the dr, not much was documented to be approved by the insurance. The insurance company said I can send another appeal but I am at a lost of how to go about getting this approved even if I did persue this with the State insurance regulatory agency. Any suggestions will be greatly appreciated. I have 60 days and I also found out that I will still have Aetna next year. Thanks again for your help Mary

Mary, I am so sorry that you lost your appeal. I will continue to pray that things work out to the good for you. You could ask the State Insurance Commision what can be done, if anything. I had to do that once on a car insurance problem for my dad. Just know my thoughts and prayers are with you. Hugs, Debra =^..^=

Mary I am going through a similiar thing with Aetna, try the 3 month presurgical regime, have the pcp refer you to a nutritionist and have them require the diet and exercise, weigh in every two weeks, have the pcp write the specifics (check the Aetna Clinical Bulletin on the web site and give it to your pcp) after the two months (your 60 day window) and say she is requiring you to do another 30 days. Aetna is the toughest insurance co, my denial has literally been because of verbage, not what I did or didn't do. Good Luck, keep in touch, there are now three of us working through Aetna for approval, we could form our own support group!

Mary, I know what you are going thru. I was denied my first time around with Aetna and I have just sent in my appeal. They said I did not have all my diet information but I did but for some reason they said they only had 2 months of doctor notes so I mailed in my appeal express mail so they had to sign for it. I haven't heard back yet. You need to check with your HR person to make sure that they are going to have a rider on your company policy adding Gastric Bypass because I found out today that at your renewal date they are removing Gastric Bypass from all policies and the only way to get it is if your company buys the rider. They did say this was not taking place as of Jan 1 but whenever your renewal date is. I do not know what size company you work for but my company is under 50 people and I was told we could not buy a rider if we had less than 50 employees so I have to try to get mine approved before 3/1/05. It is so stressful but just hang in there. You will need to get your doctor to write a letter to Aetna stating that you were on a diet / exercise plan for 6 months and that this procedure is medically necessary otherwise they will not approve you. They are really strict on approving people. Feel free to email me anytime. I will be glad to help in anyway I can. I know how frustrating this can be! Take care, Bonnie