Denied by Aetna TWICE! Do you have Aetna?

I am soooo frusturated. I have successfully completed all of the pre op requirements and I have been denied my Aetna TWICE. I have been cleared by the sleep doctor, a therapist, cardiologist and my PCP. I went thru 3 months of supervised diet by my PCP. Was denied because it was not with a dietician OVERSEEN by my PCP. So I did another 3 months of seeing a dietician AND my PCP. Both wrote letters in support of surgery. I have a BMI of 35(and have for 5 years), have sleep apnea, 5 years of doctors' records. I don't know what to do. I can't seem to get a straight answer from anyone at aetna. PLEASE HELP. If you have had RNY that was covered by Aetna PLEASE tell me what you did because I can't figure out what I'm doing wrong. I appealed the first decision and hope to appeal this one. My doctor and surgeons office cannot figure out why they are denying me. Please help. So frusturated. Thank you

I would take you case to the light weights board...they might give you some hints!

thank you, I will do that.

Get your benefits manager involved, if that person is on your side you will see some results.
this is what I had to do.
I have different insurance, but I know it made all the difference by getting that person involved.

Thank you for your response. Who is my benefits manager? You mean through work, HR?

Yes.everywhere I have worked there is someone you contact for insurance questions specificly in hr. Goodluck

I am sorry for your frustration. It is so stressful having your life in a strangers hands. When you do the 3 month program it is supposed to be a multi-disciplinary program. The program should teach behavior modification and have records of this. OR you could have gone to your physician for 6 months and kept detailed records of that. I actually did both. I went to a multi-disciplinary class that was with a nutritionists and an exercise physiologist which focused on behavior modification WHILE I did a 6 month diet with my PCP. I was approved the day they received my package from the doctor. I had a higher BMI than you and I had many co-morbidities....BUT the guidelines say that with a BMI of 35 or more, you just have to have a co-morbidity. It doesn't say you have to have them all. SO, I would definitely keep trying. Good luck!!!

I don't know the reason for the second denial, but for the three month regimen, you also have to have a PT/exercise evaluation.

how many pounds do you need to gain to be a BMI of 40?