Aetna and Denial

Has anybody had luck apealing to Aetna and getting approved for a Revision? I had to switch from my husbands Insurance when I was hired on and Aetna has denied me twice and won't accept another new revision submittle by  my Dr.

I have gained back over 1/2 the weight I have lost and ALL of my co morbidites are back and there still denying me.

Any suggestions on how to handle this?

Michaelle in Puyallup, WA

(not vitalady michele)

 

Perhaps you can find out what their criteria is for a revision. Also maybe you can seek out another dr? Maybe have them have you see a dietition and record your progress.

good luck.

I'm surprised by this post.

I have Aetna insurance, and had exactly ZERO issues getting approved for my VBG to DS revision. In fact, I was approved just days after being submitted. I know there are different versions of each insurance company, and it could be that you have an exclusion for WLS in your company's particular policy.

I wish I had some suggestions for you. Perhaps get ahold of Aetna directly and find out why you're being denied?

Hopefully, it's something simple that can be resolved!

Best of luck

Kathy

What's the reason for the denial?

Interesting. I have Aetna too and requested an RNY to DS revsion. I was approved in just a couple of days. What is the reason they are giving for denial of a revision?  Is it possible that your husbands Aetna plan has a rider that does not cover WLS surgery? If you cannot get an approval you could always go to Independent Medical Review. I don't know much about it or how it is accomplished, but I have heard that a lot of Kaiser insurers have had to go thru IMR in order to get an approval for a DS.