ATENA HELP... Bout 2 Fly ova tha Cuckoos Nest!

Playing With Emotions! NEED Aetna HELP! Original Post by Just Call Me ~coqui~ at 1:26 PM PST on 09/22/2005 Bronx, NY - RNY (09/23/2005) Hi All I seriously need help. I was sheduled for surgery 2marrow (actually 2day). Its been a emotional rollercoaster from start to finish. Send these charts, send this letter, send another letter.... Come to pre testing... We need MORE blood come again... Finally I was told that everything was a go. Report tomarrow at bla bla time, on yadda yadda floor... dont eat after 12am yadda yadda yadda.. Not to mention the lovely laxative I was told to drink today at 12PM.. Well guess what? At 4PM I was given the bad news... Surgery is canceled because Aetna denied it. What tha hell? can ANYONE help me 2 clarify just what is needed from Aetna.. I plan on appealing. Just when I decide I want my life back, I get shot down.. Does anyone have any idea what I can say in an appeal to get this surgery done. You know I am so depressed I have 2 friends that intensionally gained 35lbs to get the surgery, here I am obese by my own accord and they turn me down.. I need love right about now, none of my family or friends understand what I am feeling. Email me please [email protected] Coqui

The first step to filing an appeal is to find out why you were denied for surgery...lack of medical documents, diet history, etc. etc.

Hiya Coqui, I was initially denied by Aetna last year because I did not have 6 months of doctor supervised diet/exercise. I was supposed to have surgery in Sept of 2004, got denial in 8/04 because I only had 4 months of doctor visits. So I went the two more months (sept and oct) and had my surgery 11/11 after Aetna approved my appeal showing that I had the required 6 months of doctors notes. They dont all have to be six months consecutive, it can be 3 months from last year (even just three visits to the doc where weight came up on the notes is fine) and then the last three have to be the three months right before the surgery. You probably visited the nutritionist - get a copy of the notes from that visit, and you also visited your pcp to get a letter of medical necesity, that can count as another - get a copy of the notes from that visit, and see what else you can pull from your pcp. Then whatever is left, do them and schedule the surgery for after the last one. I am not sure this was the reason for the denial, but is the most common one with Aetna. God bless you and keep you, ~Andrea

Thank U Andrea yes that was exactly the reason. I will work with my PCD and try to complete the total 6 months. Thanx 4 the response it is a great help