Here I go again.....

The reason Aetna won't approve me is.....they simply don't think that I need the surgery.  FIrst of all, my very first doctor I thought was keeping really good "chart records" and he wasn't. When I submitted my first go around with Aetna....they laughed at his records. (his notes were all over the place...NOTHING was in order) I fired that doctor and found another doctor and thought that I had to do the 6 month diet again....I noticed that I could use 3 months from the first doctor, so I only did 3 months with the "new" doctor. With all of my doctors notes (I have HB and now Diabetes), weight loss attempt records (several places), personal note from my Mother & myself, and more (when I was done, there was a 3-4" stack of papers for the insurance company)......they still denied me.

The latest denial really upset me......my Attorney submitted a 19 page document that was recieved by Aetna in December (I got the "we got your paperwork" letter in the mail).....and then the very next day I got another letter from Aetna saying that I was denied! WTF!!!! They didn't read the submitted paperwork at all before dening me again. The dates on each of the letters were like......Dec 17 & Dec 18 (for the denial).

I have had to hire an Attorney to fight them....such really stinks (more $ going out). Right now I'm waiting on word from an External Review Board.

Well, I've been going to my primary for 6 months and am not sure he knew what he was supposed to do.  I think I can guide him on the paper work if I knew what needs to be on it when he submits his records.  He has been weighing me, checking my height and asking about my diet.  There has been no nutritionist or anyone else involved.  Will the lapband doctor's office give him guidance on what to submit and how to submit it. I saw one link where the person said you just have to know how to submit.  Well, where do I find that information?

What weight loss doctor are you working with?  I would like to get this done with. 

My doctor of choice for Lap RNY is going to be Dr. Jawad in Ocala. Where are you located? Are you going for Lapband? I was going to have that done, then changed my mind.

Are you getting copies of your chart records when you go to the doctor? You really need to look at what your doctor is going to submit to your insurance company.

If your paperwork is out of order, Aetna will deny you for that (that is what they did with me).