Ready to fight the 1st Aetna denial

Well, here we go..I'm submitting my 1st appeal to Aetna tommorrow..I'm keeping my fingers crossed....

Good Luck Candi, I have recieved my first letter also from AETNA and am really upset that they sent me a packet that were stating they needed more info and printed out the requirements..like I didnt know what they were.. I have fullfilled every single requirement like they asked even the 6mo dr supervised diet..now they are saying they need more info..I dont have another piece of info I can send...Well I just contacted Walter Lindstrom and told him my situation. and That I was willing to pay what ever fees I need to him right now instead of AETNA wasting my time of having this surgery now..when I know I should be approved and that I have did everything they needed! I hope yours goes with a breeze..just dont back down let them know your serious! again GOOD LUCK!! let us know how it goes. Shauna

Hi Shauna! I've just completed my 1st appeal and I visited my pcp today for any last minute info I could add..Why were you denied? I too did the 6 month diet plan... Aetna updated their coverage bulletin#157 on Feb.3 ..changing this diet thing..but...I submitted my info on Feb 2..So I'm fighting them!!!! I refuse to give up!!! Is Walter Lindstrom an insurance broker? Take Care, Candi

Hi Candi..I emailed you privately, but just incase you read this first..I emailed Walter lindstrom today and told him what my case was..as of not yet I was not denied. but i dont understand what more info they could ask for. I have gave them EVERYTHING!! Walter and his wife Kelly are a team of REAL GOOD LAWYERS that will fight the insurance for you for obesity surgery. they have won exclusions, and so forth..they will up front tell you if you have no chance and not just take your money and lead you a wrong path..look him up if you want his email, email me private and I can give it too you..I'm still in so much aww that I cant see straight..I really thought that I would get a approval fast due to the fact that I have gave them what they wanted..I'm hoping that it was a mistake..I hopfully will find out somthing real soon from my surgeons office.. is anyone out there that dealt with AETNA and got denied after fulfilling all thier requirements?? what was your experience like? Thanks Shauna P.s. I love the support from this BOARD!!

Shauna, I hear your pain. I was denied in '01 by AETNA for a VBG. I was furious. They didn't have the requirements of supervised diet, etc that they do now. I paid for the surgery myself. I then hired Walter to deal with them. I love Walter and Kelly. They are fabulous. If they can possibly help you, they will. Well, after many months, we won! I had lost 100 pounds before my hearing. Walter was great in the hearing. It is all done via conference call. Very legal. He is also a WLS patient himself and knows everything that we feel. He is extremely intelligent. I had a staple line failure and a problem with the band and I am back in the game for a revision. I have submitted with Humana. I called Walter and Kelly, they both remembered me after 3 years. I was impressed. Kelly told me that they no longer represent VBG patients because of the failure rate. Oh well, the research just wasn't out there then. Be confident. Know that you have the best! E-mail me if you have any questions. Candace

Hi Candace..just wanted to say that as of the 19th I was approved from AETNA...I guess some of the Fax didnt make it or whatever but it took two weeks before anything was said to my surgeons office..well they faxed it right away and made sure they recieved it..then the next day..19th my surgeons office called me in the am and told me that I was approved..I sent the recept. who worked with me on my case with AETNA making sure with paper work and always took my calls and questions..through the year...I sent her 6 Red Roses delivered..She was so thankful for them..I love sending flowers.. I'm so happy i'm over that hill...and hopefully I can help others out with AETNA also. Shauna

What additional information did Aetna say they wanted from you? It doesn't seem like you need to spend the money on attorney. Did you clearly mark all the attachments you sent? Maybe there is something specific that they are looking for, that you could resend. Call and see if you can talk to someone if the denial letter wasn't explicit. My first thought is that they want to talk to your doctor to see how many calories per day you consumed, and if there was an exercise, nutritional and behavioral component to your diet. BTW, I have heard that the Lindstoms are swamped, and not getting back to people....