What was your experience?

After receiving the third denial letter from Aetna, Obesitylaw.com has sent a letter to the company I work for, Quest Diagnostics. I was wondering if anyone has gone this far in their denials and what was the outcome? did your company support you in your decision to have this surgery and approve you? or did they uphold your insurances decision to deny coverage? I am interested in both good and bad outcomes. Thanks Jennifer

I too have WONDERFUL (gag) Aetna and was denied once and am in the process of not only trying to get them to extend the alloted time to appeal but also use the services of obesitylaw.com once I get that extension. I have read on one of the boards and forgive me but I don't remember which one it was.. That Gary was successful in overturning a denial for someone who had Aetna. Then there is Diana Cox who I think is an attorney herself. She too had Aetna. She had her surgery done then sued for reimbursement and won. Good luck with our friend Aetna.

Hi Patt, The office at Obesitylaw.com have been totally awesome and understanding. I will have to look at the profile for Diana Cox and see if she outlines her experiences with uh (gag) Thanks for the post and Good Luck to you also. Keep me posted in your journey with our friend. Jennifer

This is for both of you...Jennifer & Patt... What reason did they give for denying you? I have Aetna also, but I'm still doing the physician supervised diet. I'm pre-op and figure that I'll probably get denied the first try also

Kathy where do I begin? They are stating that I do not meet any of the requirements for surgery. My BMI is above 40, I gave them 2 years of supervised diet history. I have sleep apnea, asthma, arthritis and heart palpitations. Oh and that I don't meet the 5 year morbidly obese history. I do believe that they systematically deny surgery the first request but this is ridiculous, I have been denied three times. I hope you don't have to go through the same fight. Good luck in your journey. Jennifer

Jennifer, Holy Cow,,,, what more do they want? Has your BMI always been over 40 or just in the last couple of years? Mine has always been between 35 and 43....but it's only been over 40 for the last year or so. I have sleep apnea also...but just diagnosed in May. I've probably had it for the last 3 or 4 years because I was soooooooo tired and fatigued all the time. I finally got my Dr. to refer me to a sleep clinic in April of this year. Which surgery were you trying to get approved? I can't believe how difficult insurance companies can be. I'm retired from Verizon & we have open enrollment again in Oct. I'm wondering if Empire Blue Cross/BS would be any better to deal with. That's my only other choice. I hate to change companies because Aetna has been really good about every other claim that I've submitted. Don't give up your fight!!!! Good Luck, Kathy

Sorry I didn't reply sooner these past 2 days have been hectic.. Anyway the reason for my denial was that 1) my doctor did not provide the 5 year weight history. We can over come that as he has it 2) I did not have the 6 months with a nutritionist. So my PCP refered to the nutritionist at the local hospital. It only took her 6 weeks to call me! of course that was after the appeal period had all ready expired 3) I didn't have a year or whatever their stupid # was of physician supervised diet. What I do have is a BMI of 40+, high blood pressure (as in 210/140 back in mid-May before meds), depression and whatever it is called that makes your lower legs discolored due to poor circulation. I have been obese since 1978 and morbidly obese since at least the late 80's. I have tried numerous diets etc but now that isn't enough. I HATE AETNA!