Aetna Appeal Letter

I am trying to get approval for LapBand. I'm writing an appeal letter to go with the appeal letter that my surgeon wrote. I feel my letter needs to be most convincing, because the surgeon's letter sounds too passive (not so convincing). The main reason for denial is that Aetna covers bypass first and only covers Lapband with the presence of any one of 5 specific medical conditions (these conditions are very rare). Any advice from anyone that has Aetna or knows anything about them and their appeal process? I'm wondering what type of information to include in the letter.....How much should be facts? which facts? include any emotions or personal comments? Gary Viscio ~ I read one of your responses saying that Aetna "caves" on appeal. Do you know if this is the case with LapBand or just RNY? Thank You!!

Hi, I think I was being specific to someone's State, but yes, in our experience it has been with either the band or the RNY. BUT, remember every situation is different.