dr kuwada and appeals

okay i was denied .i  have aetna and they require your weights for 5 years.. or 3 months supervised weightloss plan. okay i have my 5 years and now they denied me for not having both.. i called justina at dr k's office and she said im the 5th person to call and tell her that and she said dr k is going to do a peer to peer thing with the docs at aetna. and it would be a few more days.. does anybody know whats going on or have yall been through this before? help help i want to crawl in a hole.. linda

I would call the insurance and ask what they require.... they should also send you, in writing, your denial... they may have recently made a change requiring both?? Good question to ask when you call. Just keep your head up and appeal!!

Hey I have aetna too. You Have to provide 5 yr weight history, 6months diet and exericise program with 3 months consecutive BUT 6 months total within 2 years ...So for example you can have june, july and august of 2007 and november 2006 january 2007 and april 2007 if you get what im saying. Nutritional and physcology exam. I was approved the first time. You can look the stuff up on aetnanavigator.com Your dr office should have known the requirements for approval. It is not your fault...It will come through for you.. This is the stuff they required from me---so I am assuming the its the same anywhere. I dunno though maybe your dr can work something out. Dont worry though It is only a small setback. It WILL come through for you...Also once the dr office submit my papers it took aetna about 2-3 weeks for approval... Hope I have been some help to you---If you have anymore questions I will be glad to help to the best of my ability...((((HUGS))))~~~carol~~~

Good morning Linda.  I wish I had some advice for you.  I don't.  I can only share with you that you aren't the only one with insurance problems.  My date was set for June 25 and then the insurance came up with a pre existing clause.  They won't approve me until.  December.  I know how you feel.  I wanted to go in my room and not face life until December.  Sorry about the problems.  Hang in there. Stacy

i know i want to crawl in a hole somewhere.. i had my hopes up and then ,, bamm..i just want to cry...we are in the same boat... linda

Hi Linda, I don't want to disappoint you, but unless they have changed, Aetna does require 5 years of weight history AND either a 6 month supervised diet or a 3 month interdisciplinary regime of diet/exercise/psych.  I know that I had to do both (I choose the 5 year weight history and 3 month regime)  and everyone else with Aetna in my Dr's office also had to do both a 5 year weight history and one of the other choices.  I was able to go online and find the requirements and use that as my bible.  Good luck!

Aetna has really gotten tough on that this year.....When people come in the office now we require ever patient to us a weight history. First you don't have to appeal your doctors office as a re-consideration review so you don't have to use one of your appeals. They will need to supply a 5 yr weight history and a 6 month supervised diet OR 3 months w/ psych/fitness and nutrition. We normally have our patient opt for the 3 month plan unless they already have the 6 month supervised diet.  Not sure why the first of the year Aetna started dening claims for people w/o the history but they did and not they do it every time.  So ask your doctor's office to file a re-consideration reveiw before you go for an appeal. All they have to do is fax in your info again and include what was missing.

i had aetna and they were hideous...oddly enough though, someone else i worked with (also with aetna) was approved after appealing.  just don't give up hope.