Denied Aetna Select - very sad - any advice helpful.

MSMALONE
on 5/31/07 6:29 am - OH
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
(deactivated member)
on 5/31/07 11:53 am - MA
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
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