Aetna is making this difficult and now denied my claim...we are fighting back

How frustraiting. My surgeons office was so sure my claim would sail through that they even scheduled a date of surgery for me, only to find out today that Aetna denied it based on past BMI's. My surgeons office is not taking this lightly but said Aetna cannot meet with them until 1/4/07 which will change my surgery date.....UGH!! This is hard enough to prepare for without all this. Thanks for listening.

Oh Darla.. I am so sorry to hear about this... insurance companies are so difficult to deal with. I can only imagine how frustrating this is. Let me know if I can help in any way. Tara

Darla, I am so sorry to hear this. I was so psyched for you getting your date and everything. That is terrible when they won't approve people for surgery. Keep your chin up and let me know if I can help at all too. Take care, sweetie.

Hi Kim, Thank you for your kind words. All hope is not lost though. Dr. Umbach is going to do the conference call with Aetna to try to get this approved. They did this for a co-worker of mine, denied for the same reason, and Aetna changed to APPROVED. Hopefully mine will end up as well. Darla

Well good. Hopefully Dr. Umbach will have luck getting them to change their mind. They just don't know how important this is to us!! I was fortunate with my insurance. They approved me within hours .... I guess Blue Shield is good that way. Keep us posted sweetie. Keep your chin up; they will get you approved!

I have Aetna too and they approved me on my first letter but my insurance consultant at the doctors office said that is about the only insurance around here that does these surgerys and she knew what to look for and she did say they are picky on BMI's. She said they would like to see it at 35 with comobitities or 40 and higher with out. I was luck because I had 49 and no comobiitities. One thing though that did help get approved was that my 5 years of BMI history wasnt enough she had to get a letter from the nutrinist to say what I was doing to change my life before surgery. I know of people who has gotten denide by aetna and it was because there BMi had not been 35 or higher with comobitites for 5 years or more. I hope this helps. Kat

Hi Tara, Thank you for your kindness. This came as a blow to say the least. Kathy was so sure I would be fine where insurance was concerned and now this. All hope is not lost though. It's just been quite a blow today but tomorrow I hope to feel a bit of higher spirits. I'll be sure to keep you informed. Darla Putnam

Darla, how awful for you. I am sorry to hear this. Insurance companies just don't know what getting approval means to us, do they! I am hoping and praying that it will be approved as soon as possible. Julia

My husband has Aetna and I did all the research on their WLS rules... if you call Aetna customer service, they should point you to the policy bulletin (sorry, can't remember exact number) which lines out exactly what you need to do to meet their requirements.... if you follow that point by point you will be approved. I followed all the rules for both his coverage and mine, but mine approved it so didn't need to apply to Aetna after all. If I can find the bulletin number I will try to post it. Good luck, Michele

Hi Michele, Thank you for the reply. Actually, I do have the details from Aetna, however, it was not clear that BMI had to be 35 or higher for the past 5 years..it only specified "Obese" for the past 5 years and obesity starts at 30 BMI so I thought I was fine and so did my surgeons office. High Blood pressure that is not responding to medication is not guided by weight necessarily and my surgeon feels strongly that they can get this overturned by Aetna since it can be proven that this problem has existed for me for many years standing. It's time we do something to correct the problem...doc tells me that worse case senario, at least the medication will work for me if I have the wls surgery and MAYBE I can go off the meds completely....(I hope) Currently, my BMI is 37.2........wish me luck. Darla