D- NIED !

After 6 months of all the testing, poking and proding. I got the wonderful news today and I've been disgusted ever since. I was told Aetna Advantage PPO 30 covered gastric bypass surgery before I purchased the plan. So after hundreds of dollars paying out of pocket, testing out the butt, driving hundreds of miles to Dr. Smoot's office, I finally had Dr. Smoot dictate a letter of medical necessity a few weeks ago. Today I was called by Kris at Dr. Smoot's and told that my plan will not cover the surgery and the case manager at Aetna stated that I will not be able to even appeal it because my plan simply does not cover it. I asked Aetna, "What about the Maryland law that states an insurance company can't deny you for this surgery." Their reply was, "that's only for small group plans, not single pay out of pocket plans, sorry." Anyone have any ideas as to what to do now? I'm at a COMPLETE LOSS. I really don't have it in me to appeal, not to mention they basically told me to not even try, because they'll just deny me again.

Chad, If you have an "Evidence of Coverage" for your plan that stated that WLS is covered, and Aetna is now denying coverage, you may want to contact the Maryland Insurance Administration office in Baltimore. They will tell you what you need to provide to them to determine whether you are being wrongfully denied coverage. I'm not saying you were, or were not, wrongfully denied. However, they have attorneys and other professionals who can help to evaluate your situation and, if appropriate, investigate with Aetna. Leesa

Chad, that's terrible. I wish there was something I could do. Email me if you want to bounce around other ideas to get approved. Is there any chance of getting on your employer's insurance, or a spouses' insurance? See if you can make it to the January meeting a few minutes early, maybe we can discuss possible options then. I think I remember you from the last meeting, you've worked really hard in the process and were really excited about submitting the request for approval. Don't give up and try to stick with local resources when obtaining information. There's alot of it out there and not everything will apply to your individual situation. Have you talked to Chris anymore about options, other than self pay? Email me - Roni rpohl2004@comcast,net

Chad - I'm sure you have already considered this already but have you looked into the self pay route and medical loan options out there? Keep fighting and don't give up. It is worth the battle. Stacy

Thanks for the support guys. I really have no other options, as my credit is very bad and I don't have the cash. Nobody will co-sign either. I've literally asked EVERYONE I KNOW FOR HELP. I'm honestly just going to have to try and get a job with great insurance that will cover it. See, I'm disabled due to back injuries and this is the only thing that would've helped me get better. Now I have to work with two cracked vertebres. I appreciate the support though, thanks guys !

Ouch. What about Medicaid?

Yup, I applied two months ago and haven't heard anything back from them yet. Oddly, I was just talking to my mom about it too. I hope to hear somethign soon. Do you know if they cover the procedure? I couldnt' find anything on Maryland Medicaid's FAQs

I've heard other patients say they have used Medicaid. I would think they would approve especially with the co-morbidity. Maybe post some messages on the main board as well. GL and keep us posted! Sending good vibes in your direction.

Chad, I'm sorry you are having such a hard time with insurance. I saw this post on the main message board and thought of you. There is a surgeon offering 10 FREE bypass surgeries... i don't know all of the details..... but here's a link to the post on the main message board. http://www.obesityhelp.com/forums/amos/postdetail/1686315.html?vc=0 I hope it all works out for you.... Pam