My Letter To Aetna (LONG)

Following is the letter I wrote that will go in with my medical info to hopefully get approval. My PCP has also written a letter and of course all the records will go. SO WHAT DO YOU THINK ABOUT THIS??? Aetna: The definition of insanity is to do the same thing over and over and expect different results. After years of dieting without lasting success and months of considering the huge step of weight loss surgery, I discussed "insanity" with my PCP, Dr. xxxxx. Together we agreed that weight loss surgery is medically necessary to prevent my health from further declining. I have a long history of yo-yo dieting. I began dieting in high school and have been trying to lose weight ever since, but the effect of all this dieting is that I'm now much heavier than when I started. Last year, for example, under the direction of my physician, I followed the Weigh****chers program and even kept a meticulous food diary and lost about 30 lbs. only to regain even more. Some, but not all of the many diets I have tried through the years are as follows: - Weigh****chers at least three separate times beginning in 1973 - Dr. Atkins many times, beginning as early as 1974 - Mayo Clinic Diet in 1981 - Followed the Diets Don't Work book by Dr. Bob Schwartz who said that if you simply stopped eating when you were not hungry anymore you'd be thin. I discovered it wasn't that easy. Tried in 1982 - Dexatrim which gave me the shakes in approximately 1983 - Body Type diet in 1984 - Herbalife in 1985 - Richard Simmons in 1988 and still have the Sweatin' To The Oldies video - Chitosan pills in 1993 - Blood Type diet in 1996 - Slender Weigh in 2000 made my legs itch terribly - Xenical in 2004 I also have a history of completing physician-supervised diets without lasting success. In 1989 I lost 72 lbs. in the Optifast program but quickly regained the weight. In 2001, I joined Weigh****chers and The Lord's Gym under the direction of Dr. xxxx. From May 2003 to May 2004, I again did Weigh****chers under Dr. xxxx's supervision, I walked for exercise and worked out at home on my Tony Little Gazelle. When I began looking into weight loss surgery, I had several co-morbidities. I am tired all the time and I am easily fatigued. I become out of breath with even the slightest exertion making it difficult for me to do my job that requires a substantial amount of walking. I have high blood pressure, my feet are swollen and hurt, my hips are painful and my back aches if I stand or walk for a prolonged time. I sweat excessively, suffer from stress incontinence and have heart palpitations. I have had bouts of depression for which I have had medication prescribed. During the pre-op testing, a few more co-morbidities have been discovered that are affecting my life due to my weight. I have active periodontal disease. It has been discovered that my blood sugar is elevated, which is contributing to the dental infection. In addition, my left foot is partially numb and my eyesight has been failing rapidly in the last several months, due to the newly discovered blood sugar problem brought on by my obesity. I have gallstones and a thickening of the gall bladder wall that is suggestive of cholecystitis. I have looked at the Aetna.com site and studied the requirements necessary to approve my weight loss surgery. According to the Aetna.com website, in order to be approved, all the following criteria have been met and supporting documentation is attached. (1) My BMI is 43.5. (2) I am over 18 years old. (3) I have tried over and over to diet as outlined above without lasting success. (4) I have followed physician-supervised diet and exercise programs, the most recent being May 2003 to present. (5) I have no severe psychiatric disturbances. I work in health care and I am well aware of the procedure and of the risks involved. I have been educating myself and have begun to take pre-operative steps to contribute to the success of the surgery. I believe I have also met the National Institute of Health's guidelines with regards to meeting the profile for surgery candidates. In closing, I am an insured Aetna HMO member in good standing. I've paid my premiums and expect value for my consideration. I have been advised that I meet your published requirements for weight loss surgery approval and respectfully request a speedy approval. Thank you for your consideration. I put a CC: at the end to my PCP, Surgeon and Attorney. WHAT DO YOU THINK??

Jan, That should do the trick! Great job! Amy

Great letter! With all the info, you should pass with flying colors. Marla

Jan, Great letter! I think you were very detailed and made your case in a very professional manner. I think the claims department can easily pull out the logic to justify permitting the surgery because it's all laid out for them. I was curious, are you doing this letter because you were specifically told by Aetna or your surgeon you had to? I'm asking because I have Aetna as well (I have Aetna POS) and neither Aetna or the surgeon asked me to write a letter and I got approval without it. I got approval fairly quickly too so I pray you get the same results! Good luck to you!

Rebecca, I wrote the letter just so that as much information is documented as possible as far as the diets I've tried and such. I also just wanted to get some of this stuff off my chest, and wrote the letter as much for myself as anything else. I also did it to show Aetna that they may decide to deny me, but I have talked to a lawyer and I won't be going away if they thought I might! I've been getting my ducks in a row and my PCP was very surprised with the letter I wrote for her to sign. She needs to change very little! I want to be as proactive as possible and I think a good offense is a strong defense, so I'm trying to take away Aetna's reasons to say no if they were of such a mind. We will know soon enough. My surgeon visit is this Friday. Pre-Op Jan

Jan, Wow! I am impressed that's a great letter. I don't think professional could have done a better job! Michelle