Denied! Aetna POS (Piece of Sh*t)

Its been nearly a year since my initial consultation. I've been going to my doctor, my dietician, my therapist - all to make sure I had everything Aetna was going to want before I submitted my request for coverage.

It appears the last 12 months and $1000 worth of appointments was pointless seeing as I got my first denial letter just the other day from Aetna.

I have that sick to my stomach feeling just reading through it. I keep re-reading it hoping I misunderstood it or that the word denied would turn into approved.

I don't know why I am so upset over this letter. I pretty much expected that I would get denied the first time around and I was fully prepared to appeal this as often as needed. I even wrote my appeal letter months before I even submitted my initial request. My family doctor was so impressed by my letter.

All the medical professionals I've been seeing this last year were optimistic, assuring me that I'd get approved, they thought I was worrying over nothing every time I mentioned what more could I do if I get denied or made comments like "if I get approved". I wanted to believe in their optimism and believe that my first letter would be an approval but I've done my research and I knew my insurance company wasn't going to make this easy for me.

The last 12 months haven't been easy and it doesn't appear as if its going to get any easier.
Time to prepare to appeal. I was so hoping to avoid this. I deserve this. Aetna doesn't care about the person, all they care about is the money. They put you through hell hoping you'll just roll over and give up. You'd have to be crazy to jump through all these hoops. But I think it shows your level of dedication and commitment.

I'm sad about this denial. I feel helpless - like a powerless person taking on the big bad insurance company. Angry that I'm dependent on my insurance to approve me because I'm not rich enough to pay out of pocket.

*sigh*  The weather right now if very fitting for the way I feel. Rolling thunder and heavy rain.

What if I appeal as much as I'm allowed and I never end up with an approval. What then?


~*~ Corrinne ~*~

Sorry about the denial.  

Aetna's been great for me.  Their requirements are pretty black and white.   What did they deny you on?   Do you have an exclusion on your policy? 

Tom

Did they say why they denied you? That is the first place to start.

Corrinne,

I've heard of problems w/ aetna before.  Although devestating - it is something that can be beaten.

I agree with the other two responses - your first step is to find out why they denied you and then provide proof proving that decision wrong.

let us know what else you need.

Pam

The letter basically is a word for word copy of their criteria. That my records do not indicate the presence of morbid obesity for 2 years as defined as either 1. a BMI over 40 or 2. BMI over 35 with any of the following - coronary heart disease, type 2 diabetes, sleep apnea or hypertension.

I was afraid of this. My weight is just at the 40 BMI but has dipped into the 39, 38 range in the past 2 years. I have co-morbidities but none of the ones on their list. I only have borderline high blood pressure which is the closest thing on that list.

I was obese all throughout high school, always struggled with my weight but right before graduation I went on a super strict diet and lost 75 lbs which put ime in the not obese range. I eventually put the weight back on and then some and have been bordering that morbidly obese BMI for the last 2 years. Its like I'm punished for losing weight.

Another thing I fear contributed to their decision was my height - like most people I round up whenever I'm asked for my height. All my old medical records have me at 5'6 which I rounded up from 5'5.5. That half an inch makes a big difference as far as what category I am considered.

Too fat for everything in the real world but to skinny to get a surgery that could save my life. Ironic. Eh.

I don't want to be this weight any longer. If I lose anything then I lose my chances of ever getting the surgery. Sure there is the chance that I could lose some weight on my own and avoid the surgery but with my past history and my family history chances are I will end up back here again. I can't bear the thought of purposely suffering at my current weight for how every many more months to satisfy some insurance criteria. Its stupid that my health problems are not good enough for them and their criteria.

This whole things just makes me want to cry. Damn letter had to come during "that time of the month". I'm already overemotional due to my hormones but this just pushed me right off the edge.

Maybe I don't deserve to be healthy or happy. This is some sort of sign of how things were meant to be for me.
 

I was denied by Blue Cross & Blue Shield of IL. After I filled an appeal letter (I found an outline for one on line) and submitted it I was approved.  I received the approval in 14 days.
Dont give up.  I had the reason for denial and then  quoted there policy in the appeal.  I quoted the benefits of having the surgery versus being on medications for the rest of my life and the complications that diabetes has on come people.

DONT GIVE UP.  I know your frustrations.  Call Aetna and ask for a copy of the policy reguarding weight loss surgery.  Then use that to quote all you've done in preperation.

Good luck  and have faith.