Denied!! Need help with appeal for Aetna.
I was denied b/c they said that there was enough proof of the 6 mths diet history. I had 7 mths, but I'm afraid the Dr notes weren't good enough. I don't think that she had enough documention on them about my progress. What else can I do to prove to Aetna that I have the proof? Get her to redo the Dr notes? or just send in another letter from the PCP and elaborate on my 7 mths of dieting under her?
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I have Aetna too. I would show your PCP your letter of denial and ask her if she can make better notes and write a more detailed letter of necessity. I also had my nutritionist and surgeon write letters. Get as much information as you can together. I also typed up my diet history for them to see everything I have tried. I went to my doctors that I have seen over the past 5 years and got my records and I highlighted my weight and blood pressure on each page and any other place that talked about my obesity. I got a really good appeal letter off the internet and I made it really personal. I didn't just talk about the medical reasons but I listed how this surgery would personally help my life. I was denied the first go around too because they said they only had 3 months worth of notes from my doctor but I actually had 7 months but they just didn't receive them from my surgeons office for some reason so I went to my PCP, Nutritionist and Surgeons office and picked up all my records & letters and then I organized it all with my appeal letter and diet history and mailed it all to Aetna via Express Mail so that I could have a signature proving they received it. This way I knew exactly what they had received. My denial was over turned within a few days. Best of luck to you. ~Bonnie