Denied by Aetna

I was denied by Aetna on Friday after I had a date already...I am so depressed. Their reason for denial was that I had no records indicating that I was morbidly obese for 24 months. Can you believe it???? I am morbidly obese now. I have a BMI of 40.1. What can I do?? Should I appeal?? Do you think I can get an approval??? Should I get a lawyer??? any suggestions?? Please someone help me!!!!!!!!!!

if i were you i would appeal the decision, i mean it cant hurt right?
I would suggest getting as many letters from different doctors saying that you need the surgery because of xyz.  If you have a commodity than make sure than they say something along those lines.  My situation is a little different from yours i got denied after i appealed 4x they said that my BMI hadn't been high enough for 5 YEARS.  My back surgeons response was "so they want you to be fatter for longer?"

insurance companies are ridicules they only do things that benefit them! i suggest appealing one to two more times if you keep getting denied.  I ended up electing to do medical tourism, and i am having my surgery in India.  They are just as good if not better than many of the places in the US.  I paid $6500 for EVERYTHING (hotel, air fair, surgery, all costs associated with surgery, and i stay there for 10 days)
I used my tax return, they have financing if you don't have all the $ up front. 

Let me know if you have any questions

Good Luck

Dani
 

Did you have medical records with your weight on it?  Thats what I have... I hope it works...  Did they indicate that it was because your BMI was so close on what Aetna considers obese.

FYI in 2006 - I got denied and had a 50+ BMI, but it was because of inadequate documentation.  It seems to me that if they dont feel your documentation is good, they will deny you.  I have also heard, that you have to follow their obesity surgery bulletin to the letter of the law, or you wont get it, period.

Hope this helps, I am in the application stages with them too!  Good luck!

Maria

Do you have a copy of they clinical bulletin stating their requirements?  It is #0157 and it lists their requirements, one of which is a 2 year history of obesity which is either a BMI of 35-39.9 with co-morbidies or a BMI or >40 with no co-morbidies.

So when you submitted (or your surgeon's office submitted, did they have two years of PCP records that showed your BMI of > 40 for the past two years?  I would say if you have that documentation you should appeal.