Problems with Aetna in Ohio?

Hello everyone. I have Aetna insurance and began my weight loss journey in February of this year. I met with the surgeon-was a great canidate for the Lap Band and so I was told that with Aetna-I could do a 12 week nurtitional class instead of the 6 month. Did the 12 week class, met with my PCP monthly on the dot and she did awesome paperwork ( I was told). Got everything needed sent in and my case was denied by the reviewer. The insurance people said that this Dr. Godiva denies everything. So, my dr was advised to do a pier to pier..in which this Dr.Godiva requested my whole file (18 pages worth). That was sent to him-and you guessed it-he denied it again. So, it's on to appeals. I am trying to stay positive-it's been about 3 weeks in appeals. I was told by the Insurance person that I am dealing with that it's a 9/10 chance that it will be approved and that my documented paperwork by my dr was great.... Anyone else every had these denials and still been able to go ahead with your surgery after all this?

I am 31 years old, attempted everything to lose this weight and dread the thought of being denied. I weigh 280 lbs and am 5'8". The surgeon I have met with is Dr. Custer out of columbus, ohio.

Thanks for your advice!

Angie in Ohio

Angie, do you know the basis for the denial? The insurance company has to deny based on something.

I also have Aetna and have been hearing some stories on the message boards about them being sticklers for trying to get approval. I've heard it has gotten more difficult to get approval from them. However, when I asked the financial co-ordinator at my Dr's office about this, she didn't think anything out of the ordinary was going on with Aetna.

I'll be seeking approval after my 3 months of nutritional work at the beginning of September. I guess I'll find out one way or another at that time.

Angie,

I did Aetna's 3 month multidisciplinary program and so did my daughter.  Both of us were denied at first.  I filed appeals on each of our cases and was then approved.  Did they give you a reason as to why you were denied?? 

I have copies of my appeal letters, etc but hopefully you will have found out by now if you've been approved or not.  My approval after filing the appeal came after about 4 days.  My daughters took longer - like 3 1/2 weeks. 

Nan

Hi Nan-I appreciate your post. I am still waiting. Called the lady that works in insurance for the surgeon yesterday and she said it's still in appeals. Once Aetna denied it-I got a letter weeks later saying that it has went to my husband's company who the insurance goes thru. So, that was the first week of August.

I am told that the medical reviewer I got for my aproval/denial denies practically everything. So, when they seen that is who was reviewing my case they kinda knew it was already a denial. So, I did write a 2 page letter and sent it to the address I was given to who is looking over my case now. So frustrating-I started this process in March. I have everything documented 110% and did the steps to a T.

I am hoping it pays off with a approval. And soon! This is taking up alot of brain space right now for me!

Thanks for your reply,
Angie