Denied

Just got off the phone with Aetna and was told I was denied today for

and I quote "6 month exercise program"  I asked if this was the 6 month diet they require and he said I don't know it says "exercise program" 

I was on weigh****chers for the first 6 months of this year and I assume that information was submitted with all my other stuff.  During that 6 months I was at the Dr several times and we discussed the program etc. 

I am thinking I should go back to that Dr and get a letter stating this, but if it is just for exercise they have got to be friggen JOKING! 

To come so far..............................................

Hey there friend!

Don't be giving up yet!  ...........another 6 months is going to pass whether you're doing one more hoop for insurance coverage or not!  You might as well have WLS to look forward to, right?  Hang in there!!!  Cyber huggss your way!

One thing I learned in all this Chris...ask again...but of another person. Ask them to copy the requirement  and mail it to you...high lighted and as a precaution...ask for a supervisior to interpret any thing that does not make sense to you. AND....ALWAYS document with name, date and badge number if they will give it to you. Hang in there and just keep trying.....visualize yourself in that outfit you want to fit into or having that experience you want to have as soon as you are able...post-op!

Gena

I received a call from someone at Aetna today.  I was called yesterday morning (before I found out I was denied) and asked if I was satisfied with my previous call.  I told them that I was not and they had someone else call me today to try and help me.

She told me the file actually said that I would be denied if did not provide proof of supervised exercise program.  So basically the weigh****cher and Dr log were fine but since it did not include EXERCISE documentation they are going to deny me.

So now to plan B while I wait for my denial letter so I can file an appeal. 

Start NOW with an exercise program, and document your visits or your efforts etc. Find out what they REALLY want, get it in writing, and work it hard! Best to be working towards their requirements even as you appeal them!

Hope you'll still be at the support group meeting tomorrow. After over a year on this roller coaster, and six months post-sugery, I'm FINALLY going to go and be there! I'm a bit of a ghost participant on this forum because I lurk here more than posting.