Denied....Now what to do?
I have Aetna PEBB. They require one of the following to qualify for the pre surgical program, Sleep Apnea, High Cholesterol, High Blood Pressure or Diabetes. So I went to the Dr's hoping to test high for my cholesterol because I don't have any of the other co morbids. So the nurse called to say that my cholesterol was high. 
I was so happy, until my case manager called from insurance to verify it from my Dr's office. The dumn nurse told her that I didn't have high cholesterol and that I was just borderline. So now my case manager says that I am denied and that I can appeal. So then the next day my Dr leaves me a message stating that she will sign me as having high cholesterol. What the hell? By this time I'm completely frustrated. I have already lost 10lbs of the 16.75lbs they required me to lose for the program and now I have to start the whole process over again. So what should I do. I have so many other problems caused by my weight but they aren't what my insurance requires me to have. I don't even know where to start when appealing. HELP?!?!
The other thing I don't get is how they can deny someone who has unsuccessfully dieted for 10 years and has a BMI of 55.
I was so happy, until my case manager called from insurance to verify it from my Dr's office. The dumn nurse told her that I didn't have high cholesterol and that I was just borderline. So now my case manager says that I am denied and that I can appeal. So then the next day my Dr leaves me a message stating that she will sign me as having high cholesterol. What the hell? By this time I'm completely frustrated. I have already lost 10lbs of the 16.75lbs they required me to lose for the program and now I have to start the whole process over again. So what should I do. I have so many other problems caused by my weight but they aren't what my insurance requires me to have. I don't even know where to start when appealing. HELP?!?!
The other thing I don't get is how they can deny someone who has unsuccessfully dieted for 10 years and has a BMI of 55.
A BMI of 55 should not require proof of any co-morbids. You need to appeal for sure.
Duodenal Switch hybrid due to complications.
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
With a BMI of 55 you should not need co-morbidities under national institute of healths WLS policies , And thats what I was told the insurance companies have to abide by.
Dusty Cassidy " It's not a real adventure unless you come home with a scar "
Current weight 219.0 Lbs My Ideal weight 188 I love my sleeve
Current weight 219.0 Lbs My Ideal weight 188 I love my sleeve
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