Re: Level II Appeal hearing - ?

Hello Everyone: I hope you all had a good time at the convention and dinner, the ones who attended. I got a called yesterday from my insurance company and I want to know has anyone heard of this level II appeal hearing and I would like some recommendation of what I should do. I was denied from my insurance company Aetna back in November due to the fact that my PCP and PA had a misunderstanding of what my insurance company required to actual approve this surgery. The policy states that 6 mo supervised diet/exercise documented by a nutritionist and over seen by my PCP. I did go in and weighed, put me on a 1800 calorie diet, did go and exercise but the PA sent in date and weight for almost 3 mos with nothing else written up. Prior to that I was with a trainer for 4 months and he wrote down my weight weekly, put me on a diet and wrote a letter for my files. All that was sent in and after they denied my, I sent an appeal in verbally and written, that was denied for those reasons documented weight loss. The day I was denied I sent an e-mail to the State Commissioner office and yesterday Aetna called me to tell me that their is going to be a level II appeal hearing on the 20th and I could be there or on the phone along with my PCP and an attorney. The reason for this is because they got a letter from the State Commissioner office. Do you know of this happening before and what do you think I should do. Thanks for any comments Mary Rafeedie

Mary, I replied privately to you also. This is an opportunity for you to go over your diet history during the teleconference. Try to get your PCP to participate, and advocate for you. Fight the good fight! Roberta