PLEASE HELP!!!

Hello Everyone: My husband's gastric bypass surgery has currently been denied by our insurance co. (Aenta.) He is so depressed! He is 28 years old, weighs 500 lb. and has a BMI of 62! He has lymphedema in his legs, hypertension and sleep apnea. The insurance co. wants him to go on a diet/exercise/behavior program for six months. His lymphedema specialist wanted a CT scan to determine the root of his condition, however, he was unable to fit in the machine. The seams on this pantlegs rip from pressure. I fear that in six months he will be unable to work. Please give me some (any) advise regarding appeal. Thank you so much for your help!!! Amy

Amy~ I am so sorry to hear that your husband is having such a tough time being approved. I too, have been denied by my insurance and am now appealing. BUT, I did want to tell you that you are at the right place for any insight and guidance. Roberta Apte, and Gary Viscio are absolutely wonderful and they reply to the posts on here. I am sure soon you will find some guidance. Can you appeal it? Go straight to the state? Will his Dr's help with the appeal? Also, if you go to the top of this page and click on "library", you can then type in what you are searching for, maybe that can help. Sorry I could not help you, but I wish you the best of Luck! Laryssa

Laryssa: Thank you for your support. I am SO stressed out! Yesterday, while online, I read that our insurance co. (Aetna) is no longer going to cover the surgery beginning January 2005! I feel such a lack of time. Meanwhile, my husband is depressed about yet another road block! A coworker suggested that I contact our senators. Do you think they may be able to help? Thank yo again for your support. ~Amy

Hello Amy, I use to work for Aetna up until May of this year. I would advise for you to go to www.aetna.com., from there you would look to the left of the screen and there would be a tab that says members and consumers. put your cursor on that and scroll down to clinical policy bullentins and select medical. Continue from that page and then select the category for alphabetical order. Select O and the first link will be obesity surgery. You would be able to read the requirements in black and white from there. Aetna has an exclusion that is written there saying a supervised diet from and physician OR 3 months supervised diet from the surgeon performing the surgery. The 3 month diet is what my surgeon has done with the majority of his patients. I hope this helps you.