Need advice and giving advice.

I have come here to post this to get my fellow members opinion. I have Aetna Insurance HMO and I was decline the surgery Roux en Y bypass. What is holding me up now is their requirements that was not met in my Doctors notes, 6 months of a weight loss program and exercise program. The point is that Aetna which I was enrolled in back in January due to New Owners at my place of work and their policey that they been with. Everything I went thru in the past is and doesn't mean a thing to Atena. I have about 6 Doctors I've been working with and I went thru all the requirements that UC Surgeons require to get this done and I was told it don't count. I want to know and like some advice. I'm looking into filing a case with the Ohio Dept. of Insurance and the Ohio Inssurance comissoner My question is will I be wasting my time with the O.D.I. an dInsurrance Commisioner. I have called and written certified letters to my Doctors stating my situation and requesting copies of my records, to send to Ohio Dept. of Inssurance. I been fighting this since July when I had heart problems and was referial to Dr. Matthews to get this weight off. This is a stress battle since then. Back in November/ December I was approved for the surgery with United Health Care, so I met with the surgeon and then I two days later I recieved a call that United Health Care as made ateriable mistake and that I was never covered. So I went to war with a lawyer advice and went thru O.D.I. & O.D.M.B, The error was an new employee not well trained gave the approvial and claim # to UC Surgeons. So sorry for making my story so long put I want to bring to everyones attention who is in the process of getting approved to. GET EVERTHING IN WRITTING. and plan on a fight and stressfull moments. I want to be a part of this fight to prove to these inssurance companies that me being Morbide Obesite is not a Lifestyle Choice in which I had heard alot of over the past few months. Please let me know if there is more I can do to get the people in this world and our goverment to role to these inssurance companies that Obesity is an illness mental & physcial. Everyday I'm getting worst on weight gain due to the stress and mobility, and I just turn 40 last Monday. Open for any advice and suggestions. please feel free to E-Mail at [email protected] I wrote to State Reps. and other high official in our goverment to help us all who is suffering from this diease. of Obesity. If I was a smoker and addicted to drugs and obesite I would be cover. But my addiction is an eating disorder. So willing and asking for advice Thank you for ur time of reading this long posting. Dan Otte

DAN I KINDA KNOW WHAT U R GOING THROUGH I WAS DENIED3 TIMES AND HAD TO START OVER I JUST SENT IN MY NEW CLAIM. I HAVE BEEN FIGHTING FOR OVER A YEAR AND EVERYTIME I APPEAL THEY WANT SOMTHING NEW SO I JUST KEEP DOING WHAT THEY ASK FOR. BUT NOW IT IS GETTING REDICULOUS. GOOD LUCK. ANGELA

Angela Thank You for the advice and encouragement Did you ever try The State Board of Insurrance? I was recomended by a coworker to go that route in which I'm in the process of doing it. I'm gathering al my Doctors note and medical files and then I'm going to their web site and file my claim, once I get a case Number I will send all my records to them certified. I heard it works as long u have a case and not haveing inssurance that excludes Obesity & the roux en Y surgery. It is so stressful what they put us thru to ge better that I'm gainng weight from all this.

Angela Thanks for you response here is the next route that I'm going check it out and try it if you haven't Here is the sight www.ohioinsurance.gov/Index.asp. I was told that their job is to get people with health problems to get approved to prevent and stop the insurance from playing game with us. They will give you a case number and then u build your case from all of ur Doctors notes and records. let me know if you ever went this route before in the past. I firmly believed that these insurance corinator give the full details of our cases. Good Luck Thanks Dan O

Angela I just found out about this today Check it out it is a medical group that works together to get you approved. www.deaconess-healthcare.com They offer all the requirments I need to get approved in one place instead running to this doctor and another doctor and so on. Check into it I am it sounds positive and the problem I had was nothing was organize or perfessional enough. I have to meet there this Thursday Night so I hope this will do it

Let me make sure I am understanding this. It sounds like you could be approved if you could document a six month supervised weight loss and exercise program from January 1 of this year. Am I correct Dan? Have you gone through their appeal process completely first before contacting the State. That to me would be the next step. Meanwhile I would talk to your PCP and see if they can put together some documentation about what you have done thus far. Then if they deny you go to the State. I would get an appeal letter ready just in case documenting all your weight loss attempts and all the co morbidities you suffer. Remember you are just a number and the insurance company does NOT care about you. If I can help let me know