My Aetna Select nightmare.....Gary help! Do I need a lawyer????????

Hi all.  I don't know where to begin.  The insurance is making this  a very, very difficult journey for me.  It has been full of red tape and misinformation.  And I see no end to it in sight.  The short version is that I'm 4'11 and weight 200lbs.  I have had a documented  over 35 bmi for the past 5 years.  I have also had chronic high blood pressure / hypertension for the past 5 years.  Also I was born with a congenital degenerative bone disease (Perthes Disease) that is affecting my hip and ankle.  In fact, my left ankle is rubbing bone on bone when I walk.  (very painful)   So when I decided to go for the Lap Band System in February of this year, I contacted every doctor I had within the past 5 years.  I collected all my records.  I got a letter of recommendation from my PCP and my Orthopedic doctor.  And then submitted all info to my Lap Band surgeon at the Cleveland Clinic  in  a nice organized, tabbed folder.  I really tried to do my homework and be prepared. I went through all the pretesting.  And my surgeon told me not to worry  -  that I am a perfect candidate.  According to my Aetna policy I had to meet the criteria of 5 years of bmi greater than 35 with A severe medical condition like...hypertension.  So I thought  - this shouldn't be bad.  I have met all their criteria.  WRONG! After my surgeon's staff submitted my initial request for approval, I was denied due to lack of supporting weight information from the past 5 years.  When I contacted my surgeon's staff regarding this issue.  I was told that they "LOST" my organized folder of medical records that I gave them. They could only submit my past 3 years of weight history and medical records they had via computer files.  Therefore....I was denied.   My surgeon's staff called me and said..."Don't worry....just fax the proof of weight for the missing years and you will be fine.  The insurance company will overturn your denial."  WRONG AGAIN!  Yesterday was my last day to get a peer-to-peer meeting between Aetna and  my surgeon to go over and correct the missing information.   I had to call my surgeons office and inform them that is was the last day  to appeal - as they had no clue.  So  Aetna had a peer-to-peer review yesterday will a fellow doctor ( not even my surgeon) and my appeal was denied.  Aetna told me that it was denied because my case was "cosmetic surgery" and not medically necessary. ???!!!!!!???   I'm not even sure if my surgeons office forwarded the correct information to Aetna.  I can't get any answers from anyone.  My surgeon's office told me that they would look into it and get back with me, as the woman who was handling my case is out-of-town at a conference in San Diego.  Aetna won't tell me anything!   I am getting the run around from everyone.   So I really feel like my case has fallen through the cracks.  I don't know if I should seek legal hel*****t.  Any and all advice appreicated.  Thanks. Angry in Cleveland.  

It sounds like to me that it is the surgeon's office who screwed up.

Sounds just like my situation!!! I will not go into it due to the length of the but let me just say that I trusted in my surgeons staff to do their job and I feel they so far have failed and that they missed something so simple.....  it took  me two days as an inexperience insurance person to understand however I was the one who had to bring the fact that my denial the first time was due to a clause written into my husbands policy. But by the time my little pea brain realized what the letter was trying to tell me the office had already done an appeal which of course was again denied due to the same issue. When I called the surgeons office they tell me "oh you are kidding they turned you down again what is wrong with them people???? "I then told her to look at the reason and she said well I can't because I do not have the letter in front of me. OMG I wanted to say" well get up and walk across the room and find it fool!!!" But I was nice and said there is a clause with my husband employer policy.  She then says" REALLY I thought we checked that?" I then had to explain that it was not an exclusion but a clause and that in order for me to meet the guidelines I had to have everything they wanted. She tells me she will do her best once she gets the second denial letter to find out what they want. She said maybe all that has to be done is the dr has to talk to them. I told her that was an option given in the letter. Now here is my question why did they waste my appeal and not first look into the reason behind the denial the first time?   Anyway I feel you pain believe me. I have had so many red flags waved at me about this staff and yet I have no clue what to do about it. I have one last appeal left and I feel they will mess that up too. Sorry this was so long I guess once I got started I could not stop. Sorry LOL