I HATE AETNA PPO!!!!!!!!

Talk about an insurance company that makes absolutely NO SENSE! Friday, July 25, 2003, I called Aetna to check on the status of my precert. for WLS, expecting to hear that no decision had been made or they were still waiting for such and such - only to be told that my surgery was DENIED!! This is just the beginning. I'm NOT giving up! I WILL have this surgery, Aetna be damned! What's especially frustrating is the fact that I've had this insurance for over three years now. I first considered WLS two years ago. I went to Dr. Harold Engler's group in Augusta, GA. Everyone there was very helpful and quite ready to do whatever it took to get me approved. Well, sure enough, surgery was APPROVED within two weeks. Unfortunately, around the same time that my surgery was scheduled, my now-ex husband and I separated, I became ill, and I just plain chickened out, convincing myself to give the traditional, but always failing, diet and exercise route one last try. As usual, I lost weight - only to put on the 60 lbs I'd lost PLUS another 50 lbs - 110 lbs in two years! During that two-year period, I met my soulmate. I became pregnant and endured a very difficult pregnancy. But now I have the most wonderful, beautiful daughter, Aurora Jade. And it is so frustrating that I cannot be the mother to her that I want to be. Don't get me wrong. My now 13-month-old little girl and I are extremely close. I love her more than anything in the world, and vice versa. But I can't hold her very long standing up. I can't take her for walks, even down the street and back, because my back will go out. I have to have my husband or my mother do grocery shopping or any kind of shopping, as I cannot endure the walking, even from my car to the inside of the store. I have the bathe Jade (as we call her) in the tub with me, since the weight of my belly pushed against the side of the tub while trying to bathe her like most people do feels like it crushes my lungs and I cannot breathe well at all. This is the most frustrated I've ever been in my life. PLEASE, ANYONE WITH AETNA PPO WHO HAS BEEN DENIED, WRITE TO ME! EITHER ON THIS BOARD OR VIA EMAIL. YOU CAN REACH ME AT [email protected]. I've not received an official denial letter yet, but I don't want to wait for one. I've tried researching Aetna's appeals process, but their idiotic website doesn't provide any such details (gee, I wonder why). Please help me. I WANT TO LIVE AGAIN! I WANT TO BE ALIVE AND HEALTHY TO SEE MY DAUGHTER GROW UP!! Thanks so much, Amy Young

Hi there!!! I'm in the same boat with CIGNA HMO because my file was missing something, or so they say...So, I am also appealing my case and have written what I hope is an excellent appeal letter... If AETNA is not giving you the information that you need, then I suggest you keep asking for supervisors until you get to someone who can help you. After calling and calling and calling, I finally got the guidelines faxed over to me from CIGNA so I can continue with my fight!!!! Don't give up! And, file a complaint with either your state's medical commissioner's office, your state's local office of insurance, and/or your state's Dept of Health's Office of Managed Care---maybe they can help you...

I also have Aetna PPO and I hate them...I thought we were getting a great insurance in may when we switched from regence BS/BC well they say they want 5 years of weight history of being MO I have 5 they state I have only 4 well then someone there lost the chart with 1999 anyways least of my worries then they say you have to have PCP Charted notes with 6mo of diet exercise that failed within 2 years of surgery..well I've had weights 1200 cal diet mentioned..dont know how much my PCP charted down on paper..I'm diabetic with PCOD and on a diabetic diet...I said doesnt that count...my case nurse who is ahead of my packet was very short and rude I think and I said I can send her more of my files but she said really rude I DONT NEED NO MORE THEN 2YEARS Nothing else will help your case and dont send any hand written letters from self and extra paper work for me...here I thought Aetna was a great insurance company...you've got to be kidding me...I said well i know i have forsure 3mo charted of weight from may on she said well close your case and wait till you have 6mo...I dont understand the whole process..If I could diet and lose weight would I be doing this no...I've been MO since my first child...15 years..always been 100lbs over or more...why cant they just understand and look at what a person has instead of having this 6mo stupid diet history thing...can anyone make sense to this criteria??? anyway around...no....i'm doing my months...just to shove it in their face and get what i'm needing to help me live and have a good health down the road.