Aetna Difficulty

 hi, i was denied, and how does the appeal process work, and can you represent yourself?
also, can a person get all their documents from Bariatric Institute and move to another company?

Hi, I'm not sure what surgery you are looking into.  I too have Aetna and am in the process of getting approved for the VSG.  I am hopeful as I have a high BMI, a lot of co-morbities.  I have heard that Aetna does approve VSG's for those reasons.

On the VSG forum there is a woman (I think it was Sleeve Jeanie) who has a appeal letter on her profile.  It has been used by several people (it's generic and you or your doctor put in the specific information for you), and those people have been successful.  I would post the question there if you are hoping to have the VSG, or really they are very nice on that forum and will answer you no matter what kind of surgery you are hoping to have.  I hope this helps you. 

From what I understand if you can document and keep persisting, it is possible to get your denial reversed.  The squeaky wheel gets the grease.  A lot will depend on your BMI, and what co-morbidities you have.  If you are being denied due to the type of surgery you are requesting, you can often change your request, get that approved and then find a technicality which makes it necessary to change to the type of surgery you want.  Example.....if you want the VSG but are denied due to it's considered 'experimental', then get approved for the RNY instead, then if you have reason to take NSAIDs for pain/arthritis/etc (NSAID's are not allowed post-op with the RNY) you can appeal on that ground to get them to approve the VSG.  I hope that isn't too confusing of an explanation.

Best wishes in this journey. 

 I was denied at first too and what I did was just reapply. get referrals if you have to and just keep reapplying, the appeal process can takes MONTHS, so just ask the Bariatric Institute to keep submitting paperwork and reapplying and such.