Aetna Appeal Letter

Hello there. I have recently "completed" or so I had thought the necessary requirements from Aetna to be approved for a the gastric sleeve surgery. I finished my classes at Ohio State Medical Center on July 27th. In 2011 and 2012 I did not take any trips to the doctor, I travel for work so because my last visit was in 2010 I was denied due to not having 2 consecutive years of proof of obesity. I was hoping to get some suggestions on what I can do in this situation. Thank you so much for taking the time to read this.

 

Sincerely,

Justin Tuttle

Hi Nan I was just informed today that I was denied my surgery. Can you please email me the letter of appeal so I can start the process. My e-mail address is [email protected]. I would greatly appreciate it. Aetna is saying that I didn't meet the criteria for the 90 program. They stated that they only had documentation for 56 days which is untrue because my surgeon would not submit before 90 days! Please help me! Keerah 

 
This is in response to your inquiry regarding the status of the
authorization for surgery under case number xxxxx
 
A determination has been made and a letter was mailed to you on
11/25/2014 advising after reviewing all the information provided and
based on our Clinical Policy Bulletin 157; Obesity Surgery, the repeat
bariatric surgery is denied because the documentation submitted shows
you did not have adequate success (defined as loss of more than 50% of
excess body weight), 2 years following the primary bariatric surgery
even though you were compliant with a prescribed nutrition and exercise
program following the initial procedure.

The letter includes information on how to appeal this decision.

 

So, any idea's what to write back?

I paid for the mini sleeve only lost about 20 pounds.

Then got cancer and stuck at home gain weight back...also the mini sleeve was only a research operations.

Any help would be great!

Is there anyway you can help me with the appeal letter also. I never thought I would have so much trouble with Aetna. Thanks!

Hello Nan, i have aetna insurance and i was denied on 3/11/2015 for a gastric bypass revision. they denied me because i gain weight in the 6mths weight loss requirement program. i cannot exercise because i have a bulge disc in my back. i was told that i could fight against the denial but i don't know what to put in my appeal letter. please help me.

Hi Nan2008,

 

I know you posted this response 5 years ago. But, I was hoping that maybe you can help me with my appeal letter too. I was denied surgery by Aetna because they said that I gained weight during my supervised nutrition program. I'm desperate to get this surgery. Hoping you're still on this forum.

 

-Khoney3

Hello I'm looking to have surgery and I've been denied twice. My bmi is 43 and I did the physicians path and I have sever sleep Apnea and prediabetic but they said it's not a medical necessity. Would you be willing to help me too... 

I'd like information on the appeal letter. I have been appealed by Aetna and need help.

Your family pictures look great hope all are well.

I would love to get information on how to file an appeal for Aetna. I had lap band in 2011 but due to serious acid reflux and ulcers, I need to have it removed. I lost weight with the band and kept if off. I also had pain with TV and the way it was sitting in my stomach. I would like the revision done but bc my reflux was so bad, I have to wait 60 days to get the revision so that my esophagus may heal. I'm nervous that Aetna will deny the revision. Please help.

Hello, Try to find out specifically what they need in detail through Aetna. Call them directly speak to a rep, make sure you get the name amedocument evrything she says and date and time, and ask her what she needs from you.I hope I understood you correctly on that. I hope that helps. You need anything else,feel  free to message me.I wish you the best.