DENIED!

Well I just called Aetna since I have not heard anything from Weight loss surgical center.  I have found out that I was denied on 11-21-07 and I  have not received the letter as of yet.  They state that my surgery is NOT MEDICALLY NECESSARY!  So I asked for the name of the person who stamped their name on my request and all the lady would tell me was the initials were DM. So now I have the president and CEO of Aetnas Office and Home number and am debating on calling him directly. WHAT TO DO, WHAT TO DO?! Well I guess I'm off to the world of appeals.

I'm don't know much about appeals but at the seminar I went to they gave us this website in case we had problems with insurance approval.  www.obesitylaw.com  there is also a fourm on here called insurance help maybe they can assist you as well?  Good luck and keep fighting. Bev~

I have found out just now that I was denied because of lack of documentation. Aetna wants 6 months of a supervised diet and exercise program, a psych evaluation, and documentation that I've been overweight for the last 5 yrs. So I guess it will be another 6 months without surgery. I just hope I can make it that long.

Sounds like you don't have the documentation they ask for. I had Aetna and was approved nearly 5 years ago. Have you ever went to weigh****chers, joined jenny craig, slim 4 life, went to the drs and they weighted you and recorded it in your chart? Your PCP should have some of the info requested. Think of any and all diets you have been on and write it in a letter to aetna. Ever went to the dr and been on diet pills? Get a copy of your records and sent to them. Hope any of this helps. I wrote a heartfelt letter to Aetna with all the diets I had been on and what my weight was each time what I had lost and regained. Told them what was wrong with me and how much the surgery would do for me. They accepted it. Hang in there!!! It will be worth the effort. You will be our prayers!!!

Could you please give us the phone numbers for the president and CEO of Aetnas?  I also have Aetna and those numbers would be good to have if they give me a hard time. Pretty please?

Hello, I had to jump through all those hoops too and time has gone by fast. I started in  March and my surgery is on Dec. 12th. Good luck and get started right away with your pcp and the supervised diet. Take care, Connie

Hang in there, what your insurance is requesting is not unusual.  I had to have a documented weight loss program in my past and another one for at least 6 months in the last year.  My insurance started covering the surgery on 1-1-07, so in January, I started a supervised diet and in July, I had surgery.  I had previous documentation from Jenny Craig  in my past and my PCP had my weight for several years documented just from where I would go in for appointments.  It was very frustrating having to wait another 6 mths but what I did to help is got all my pre-lim appointments out of the way.  Then the day I was told I was approved, I started my liquid diet.  My appointment with Dr. Edwards was a week after I got approved and then the next week, I had surgery.  I knew he was going to require at least 2 weeks of liquid but as I had already been on it for a week, I just had to wait a week after my appointment for surgery. 

I also looked at that 6 mth diet as a way to get a jump start and practice the skills I would need for the surgery.  I lost about 10 pounds in that 6 months, which isn't much, but it was still going down.   Keep trucking along, you will make it!   Jennifer

Thank you for your advice. I started today by seeing my PCP which she is really into supporting people for surgery not just telling you Diet and Exercise! She seems to care. I started a food journal today and had blood drawn. So 6 months won't seem so bad I guess. I have set a goal to lose 10% in 6 months. I will blog about my journey on my OH page.

I was in the same boat with Mercy, but I wasn't denied just need more document and I assumed it was a denial and contacted obesitylaw.com for assistance and they were just awesome.  They told me what they charged and forward the forms to me, but then I got a email for Gary and he informed me that the maker of the lapband port contracted attorneys to fight the appeal AT NO COST TO ME...sounds like a winner to me.  so I would think about contacting them.  The only thing is that your surgeon has to request the forms.  Also my surgeon told me that if your have a high BMI, they can refuse you as well because stats claims that people with high BMI doesn't do well with the lapband.  And I was ask to try and get my BMI down....but anyhoo...good luck in your journey.