DENIED BY AETNA ON APPEAL

I am new to posting here and I am super frustrated!  I started my journey on July 21st.  My surgeon made me feel like it would be a pretty easy process and I expected to have my procedure by Sept. 18th and then I got my first denial.  I have 22 years worth of weigh****cher books.. I can show my weight for 22 of the last 26 years and sadly my BMI always qualifies me with the exception of a year or two.  On the first denial they said I needed 3 months of surgeon-supervised diet...........SO..........we did that..and re-submitted.  I just got my second denial and their reasoning makes no sense.. there is just jumbling of words that make no sense and when I call AETNA the representatives don't have a clear answer.  When my surgeon's office called they were given two different reasons by two different reps.  I am at a loss as to what to do.  I am going to try and get an attorney's advice and we filed another appeal yesterday..  I have an Aetna PPO that is supposed to cover this, providing your BMI meets requirement and you have the 3 month supervised diet.  UGH...................PLEASE advise if you have any suggestions..

Hi, Jenn. I know this process can be super frustrating. Which route did you choose to do, the 6 mth physician or the 3 mth multidiciplinary? I have a detailed list of what i did for the 3 mth program as well as letters that I drafted and had my PCP sign. Several people on here have found success using them and I would be glad to share them with you if you send me your email addy. :)

We did the 3 month multidisciplinary. which was me following what the surgeon told me to do - lifting weights and eating only lean meats and veggies... This diet was so strict that as soon as the 3 months were up, I am doing poorly now. I am a stress eater and all of this has STRESSED me out............so I am at a loss as to what to do.  It sounds like they wanted me to have a fitness trainer and nutritionist as well?  What is annoying is that my surgeons office should have known this right? They are all shocked that I wasn't approved because so many have been approved that did what I did.  I would really appreciate any help you can provide. Please send email to [email protected]...  Thanks!

Jenn, unfortunately, what your surgeon told you to do is not what Aetna wants. Do you have a copy of the clinical policy bulletin that lays out the guidelines of what is required? I'm going to email you the step by step list of what they want. Let me know how it goes.

Hi Rosie,

Would you mind sending me the letters that you have drafted?  I am concerned because I have to a 5 year weight history and my weight history hasn't always been with a BMI of 35 so I need all the help I can get to get the insurance company to approve.  I'm trying to do surgery prior to the end of the year so I need a quick approval.  Thanks!  My email address is [email protected]!