Denied Aetna Select - very sad - any advice helpful.
Hello friends....
Today I found out the disappointing news that Aetna Select has denied authorization for Lap Band procedure. I was told that the denial was based on the fact that they (Aetna) had insufficient information that I have been morbidly obese for the last five years. I was also told "the letter" is in the mail.
I am very, very upset. And I don't understand why they don't have the information.
My surgeon is Dr. Schauer at the Cleveland Clinic. After completing the pre-test requirements with my surgeon, I supplied them with 5 years of detailed records from old doctors in other states.
My guess is that one of two things happened:
1) The Cleveland Clinic failed to submit all of the records that I gave them.
or
2) On some of my past medical records, my height is incorrect. When I was measured for my pre-testing requirements in April of this year, my correct height is 4'11 (barefoot). In the past, when at other doctors visits I was rarely "officially measured" only weighed. I was simply asked, "How tall are you?" And being that I have always hated being so short, I would reply. "5'1 or 5'2". So on some of my records that I submitted to Aetna the incorrect height listed makes my BMI fall (just under 35). I guess I have in a sense "shot myself in the foot" by giving my incorrect height.
So what now? Am I done?? Should I just come to terms with the denial and move one???
***Also...Aetna Select told me that they are offering me a "peer-to-peer". I am soooooo upset. And I don't know what to do next.
Any and all advice appreciated.
Sylvia
Don't give up. You may not even need to appeal. I was denied and got the letter last saturday because my bmi was too low. but my doctor called the insurance company's doctor and explained that my height is actually a half an inch shorter but bmi calculators don't measure by the half inch. they approved me over the phone. maybe your doctor could do the same.
i have a different insurance than you, but the problem sounds basically the same. i know how disappointed you are. (((((hug))))))
good luck. ~cheryl