Denied.

Well, I got the letter from Aenta yesterday. Denied. I will fight this, I will not let them basically kill me slowly by not allowing me to have this surgery done. I knew it was going to be a fight, and I am ready for it. Does anyone have any good appeal letters they could show me to use as a guideline? I have a couple, but I would like to see some more just to get the feel of it, what I need to include, ect, ect, ect. I had been expecting a denial, so I am not as heartbroken as I would have been had I been expecting the approval. Little upset, but like I said, I am ready for a fight. I love a good confrontation, its good for the soul. (I think so anyway), and when I say confrontation, nothing nasty, just blasting them with the facts, and making them eat their words. Thanks for the copys of example appeal letters in advance. You guys and gals rock my socks off!

Scott, I'm sorry to hear that they denied you. Did the letter state why? I'm hoping others jump in with appeal letters. I would be sure to get your pcp and surgeon involved in the appeal process. Often, a letter from them and one from you clarifying any facts misunderstood is often enough to turn the table around. Sherri

you need only address the reason you were denied.....email me and i will send you some copies of great appeal letters,

Hey Scott. Sorry to hear about your denial, but don't be too upset by this. Aetna is VERY by the book, and they strictly follow Policy 0157. I posted yesterday about Aetna, so look for that. I did so on the main board too. Send me your email address, and I will forward you everything I got yesterday.

Scott I also have AETNA and was denied the first time around. What I did was got in touch with every Dr who had seen me the past 3 years or so and had them write a letter of medical necessity for me. I also got my complete medical records (about 4" thick) from my PCP and sent it to AETNA. I even got a letter from my eye doctor stating that being morbidly obese and being a diabetic would lead to blindness unless something was done soon. After that barrage of paper I was approved in about 2 days after they received my bundle. I really do not think they were about to sort thru all that medical information. The first thing is to be sure you address the reason for their denial and then go from there. Good luck Dan

Scott, I also was denied the first time around w/Aetna. Hang in there...like everyone else has already told you send in whatever documentation you have to plead your case and address the reason they denied you in your appeal letter. Please feel free to read my profile and what I went thru w/them. Best wishes. Lisa D.