Suggestions about Appeal

I have been denied by Aetna (with additional "employer hoops" to jump through!) I know several other Board members who either work at, or their spouses work where my hubby does ~a manufacturer in west cental OH~ some of you HAVE been approved after one or two appeals. I am looking to YOU for suggestions on what to write in my appeal to the Employer.. and If I should include a letter from my PCP Thanks SOOOOOO much! ~Deb

Deb, I am really sorry to hear about your denial. I am in week 2 of a 12 week multidisciplinary regimen. I won't even be able to apply for approval until I finish this program.....and....I have Aetna PPO. Were you denied approval of the lap band, or for surgery...period? I wish you luck with your appeal, and will be watching your profile really close...

Deb, What I did was to have my PCP write a letter and my cardiologist. My cardiologist also sent along an article in support of the WLS pertaining to metabolic syndrome. Additionally, I wrote a letter myself. It was probably 4-5 pages long outlining my health issues in regards to my obesity as well as pointing out my family history and my relative's lack of longevitiy due to the morbid obesity. In otherwords, due to my family history and if things were not changed, I, too, would end up not living a very long healthy life (I tried to make it sound like they were signing the death certificate as well as going to spend TONS of money on me for my current PLUS additional health issues as time progressed). I would suggest gathering any and all articles from medical fields that support your surgery and have whatever doctors you can to write to support your decision. One thing I ended up telling them too was that THEY do not know me-my doctors do and if my doctors feel this is needed WHO are they to say my life isn't worth getting the approval for the surgery? You gotta get tough with them Deb! If you need any help, feel free to e-mail me privately! Beth