Hello,
I was just wondering if anyone could provide an answer to my question,
Gary
? I had originally submitted my predetermination claim back last year in April and was denied for no 6 month diet... completed six month diet in Nov and sent in that documentation to
Aetna
to appeal my denial. Supposedly they forwarded my information to my employer (we are self-insured) and I received a denial from them for no 6 month diet history?? WTH? Spoke with the lady in my HR dept and questioned how could I be denied for the same thing when the information I supplied for my appeal was the 6-month diet history?? She advised that
AETNA
had not sent that to them. For the life of my I cannot figure out what they sent to them? So she advised that if I had that proof of diet history with me, to fax it to her and she would submit to 3rd party for review (last appeal). Received notice from them that I was denial again for no history of being overweight for 5 yrs and because I was depressed and they suggested psychiatric counseling?? This was all information that
AETNA
had, so why my employer didn’t have it, was beyond me.
My point being...that was my last appeal...they advised me to get the needed information and resubmit to
AETNA
for a new predetermition claim. I actually went ahead and got all the documentation from my doctor, AETNA, and my employer that was submitted on my claim and compiled it all together myself, so I will know exactly what is submitted.....
My question is, if I submit a new claim for predetermination and have all the information that is needed..Can they look back at my old claim and deny me for the depression (which according to their requirements is not a contradiction to having surgery??) Or are the claims reviewed separately?? Hope this make sense. Thanks in advance for any help you can give 
