Appeal process for Aetna

I've just found out from the insurance company that I was denied RNY because my BMI was not over 40 for 5 years yet I've had high blood pressure for 7 years & BMI over 35.   What should I expect next?

Depends on the plan really.  Between the battles with Aetna and my employer (I have a self funded plan) this easily puts me on top of the "im about to break" pile! I've dotted my i's, crossed my t's and probably quote the clinical policy bulletin as I sleep yet I still get denial after denial.  I sincerely hope you don't have to go through what i've gone through with Aetna.    My advice:  Know your plan type. Get familiar with the clinical policy bulletin on Obesity Surgey and use it as a "to do" list. Best of Luck

I know how you feel about getting denial after denial.  I was in the same boat for about 4 months.  The denials were all over items that were already in my chart.  Finally, I typed in a search for the insurance commission for my state (BCBSIL).  When I found the site, I was amazed at how easy it was to open a complaint...just type in my insurance information, and write a short note about my struggle.  I was contacted by my insurance company within 24 hours, and they informed me that THEY were going to resubmit my information for me.  Within 48 hours, I was contacted with the news that I had been approved.  Since then, I have had at least one friend go that same route, and be immediately approved, after struggling with insurance for about 11 months. My plan was self-funded, as well, and since it is self-funded, there is nothing the insurance commission could do about my complaint, but they did notify my company that a complaint had been registered.  That was enough for my company to take a real close look at my application.  Insurance companies DO NOT want to tangle with the insurance commission!