Aetna Denial

Chris S.
on 10/5/08 11:23 am - Tempe, AZ

Was denied by Aetna HMO (open Access) they say I have been approved for all the requirements except I did not have 6 months physician suppervised exercise documentation.

I have been cleared through pulm, cardio, phyc eval, nutritionist eval, letter and records from new PCP, letter and records from old PC, 8 months weigh****chers weekly weight ins, I attend support groups, seminars, and have letters attesting to that.

I am hoping that with all the other information I have they will accept me on the three month multidisiplanay program. Once I received the denial I went to PCP to document everything and put me on a diet plan and have joined the Y.

Just received the letter yesterday for the official denial so now I have to put together the appeal.

I don't want to wait, I am impatient and want this now!

bikerbetty
on 10/6/08 3:50 am - CA

VBG on 01/14/09

sorry to hear you got denied. I know what you are going through .I have been denied twice and now I am waiting for the hearing department they said 60 days. I am like you I want it now. The just want you to jump through so many hoops. well good luck have a good day and don't give up.

(deactivated member)
on 10/20/08 4:26 pm - sunny, CA

Hi I see that you are in CA. When you say hearing dept do you mean DMHC? If you have exhausted all your appeals through your insurance then contact the DMHC and ask for an IMR. If your insurance doesn't have an exclusion for WLS then the DMHC will most likely be able to help you. They are very pro WLS. If you have contacted the DMHC already good luck if not contact them asap and tell them about your situation and maybe someone there can tell you what you need to do next.

Dapme
on 10/6/08 7:06 am - kingwood, TX

DS on 03/24/09

This whole insurance thing is so frustrating. I to have Aetna, but I am just starting the process. I thought if you had documentation of a 6 month supervised diet that was good enough. How can they document your exercise? Do you think it would be enough if when I go for my weighins with my pcp that she documents that I went for 3 walks each week or do you think Aetna is looking for you to actually belong to a gym? I to thought about the 3month mutidisplinary regimen...but it all seems so confusing! Good luck to us both.

Chris S.
on 10/6/08 7:23 am - Tempe, AZ

RNY on 03/10/09

From what I understand and what I have researched and read here the three month plan only works if you have behavioral modification and nutritionist consults during that three months.

When they are looking for documented exercise my understanding is they are looking for a log of what you did, how long you did it, what days you did it, sign off and discussion with your PCP, anything and everything you can think of. That is why I joined the Y. It is $42 a month and it just goes with the documentation.

I am going to call Aetna today since I just received the letter and ask them exactly what documents they are looking for regarding exercise.

Dapme
on 10/6/08 7:30 am - kingwood, TX

DS on 03/24/09

Great. If you find out eactly what exercise docs they need ...pls let me know. I have severe knee arthritis ..so I dont want to join a gym. Walking works best for me..but how can I document that?!

Let me know your progress!

Chris S.
on 10/6/08 7:40 am - Tempe, AZ

RNY on 03/10/09

On hold with them right now. Trying to explain to her I want to talk to someone that knows about documentation.

Dapme
on 10/6/08 8:35 am - kingwood, TX

DS on 03/24/09

lotsa luck!

LucilleBB
on 10/6/08 11:54 am - St. Cloud, MN

I am at the same place!!! My insurance company is different, but I was denied for the same reasons.
It's so depressing!

R. c
on 10/7/08 1:17 am - nashville, TN

Hi there. I have Aetna Open Access, did the 3 month multi-disciplinary regimen, and was approved 4 days after info was submitted. Step by step, this is what I did:

-I saw my PCP once a month for 3 months (4 visits in total).

-I saw my nutritionist once a month for 3 months (4 visits in total).

-I saw a physical therapist once, and she developed an exercise plan for me.

-I went ahead and had a psych eval, even though it was not required.

-Finally, I typed up a summary letter to go along with office notes for each visit with my PCP and she signed them. These letters detailed what I had been doing each month, as far as preparation for surgery.

While i was afraid of denial, apparently this info was enough (along with one set office notes for each of the past two years documenting a history of obesity) to be approved.

Info was submitted on 8/25, I was approved on 8/28, and had surgery on 9/16.

If there is anything i can help you with, please feel free to PM me.

~* Rosie *~ 2-16-10

Post Reply

Aetna Denial

Our Mission

Follow us

Links

Select Photos

Aetna Denial