Appeal question....

I've been denied for lapband surgery. I just sent off my appeal paperwork yesterday. My insurance co. (Aetna) is going to stop coverage of ALL obesity surgery as of January 1, 2005. My question is.....if I have been denied in 2004 (when it was a covered procedure)....and if they deny my first appeal.....am I out of luck on Jan. 1, or can I still appeal based on the 2004 coverage/criteria? I'm just afraid they will try to stall so that I don't have time to appeal before then. Also, if they approve this appeal...do I have to actually have the surgery before Jan. 1, or is the approval good after their policy changes? I'm just trying to figure out if there is time to squeeze everything in before Dec. 31. Thanks for any advice you can give!!!

I don't have Aetna so not sure this will help in your case, but my insurance told me that IF I started the process in 2004, then my appeal(s) would still be good in 2005. Good luck

Check your Summary Plan Desciption booklet under Appeals for time restrictions. ERISA gives you 60 days to appeal, but most plans are more liberal. Hope this helps, Roberta