DS v. RNY --Aetna

As hard as Aetna's new requirements are to meet for obesity surgery, I managed to get approved on my first try -- for the RNY, when my surgeon, my PCP and I all requested the DS. I have now appealed this through two internal appeals, with all the supporting information you can imagine -- I have a PhD in molecular biology AND I'm an attorney, and I did a tremendous amount of research, both here and on the Yahoo AetnaWLS and DS Insurance Authorization Problems boards and www.duodenalswitch.com boards, so I think I hit most if not all the high points. In addition, I obtained from another Aetna patient who had been in the same cir****tances a letter he had received from his External Review of his denial of the DS, in which the External Reviewer overruled Aetna's denial, and Aetna's letter to the patient stating that they accepted the decision (and they paid for his surgery). Aetna totally ignored it. I am now at the CA Dept. of Insurance "Independent" Medical Review stage, and I am quite confident they will also uphold the denial -- they have NEVER overturned it, 0/24 tries. I am also trying to determine from my company's HR department what the next step is. If it is to sue, I will investigate not only filing a claim on my behalf, but also to see if a Class Action Suit would be in order, perhaps including other insurance companies such as BC/BS that are refusing to cover this surgery, although they will cover the RNY. Any advice or help that anyone has will be gratefully accepted! Diana Cox