Aetna Denial Letter

Hi everyone! I am new to this site and I have been researching and working towards WLS for over 1 year now. (Actively 1 year, looked into it over 5 years ago) I just got my denial letter from Aetna HMO and I'm really disappointed. I have done the 6 mth. nutritionist, dr follow ups, psych evaluation, shown 5 years of obesity!!!! I have severe sleep apnea and was STILL denied the surgery. I think it is because my PCP has kept REALLY crappy notes for the last 11 years that I have been going to him! Has anyone had to appeal a denial from Aetna? If so, any support would be great!  I am really so frustrated that I just want to forget the whole thing. . . .

I don't have Aetna but I have heard that you have to appeal sometimes. Don't give up! Keep fighting, you will be happy you did when you finally get that approval letter! Off to watch Big Medicine!!

  Hello....I have Aetna and was turned down and we appealed. They approved me in a couple of days after I was turned down. Have your WLS give them a call and see what happens..... Do you have a WLS? Dave

Not to worry! I went through thre denial letters and was approved on the fourth try. If AETNA refers to a certain policy bulletin or guidelines for requirements follow them exactly in documenting an appeal letter. I also included in my last denial the Ohio Insurance Commission forms that I planned on filing should the final appeal be denied because I had met all the requirements especially for "medically necessary" which fits you do to the comorbidities you have. Patience and waiting them out are worth it in the end. Now with my reconstructive surgery Aetna has approved tummy tuck, upper tumy tuck, thighs, arms and lipo on the first try. So once your surgery is approved for weight loss go to your PCP for rashes, back ache, etc to get your reconstructive surgeries paid for. Best wishes. Lucky Lu

Lucky Lu, did you have a medical reason that they are covering your plastics or does your insurnace company just do that? Thanks in advance Colleen

Hello,   I am new also and just got a denial letter today in the mail from Aetna.  It appears that the company I work for no longer includes coverage on this type of surgery.   I started the process last September and at that time coverage was included; however things changed after open enrollment in January.  A member of human resources has also informed me that there is no grandfather clause. Imagine my frustration after months of pre-operative procedures to get to this point.  I am just sick about it -so I can feel your pain. If anyone has any suggestions I would be so greatful!