Same insurance here in CA and looks like we have to pay a lot of ouf pocket becasue we havent met our deductible.....just switched to Aetna this week :(

 
This is in response to your inquiry regarding the status of the
authorization for surgery under case number xxxxx
 
A determination has been made and a letter was mailed to you on
11/25/2014 advising after reviewing all the information provided and
based on our Clinical Policy Bulletin 157; Obesity Surgery, the repeat
bariatric surgery is denied because the documentation submitted shows
you did not have adequate success (defined as loss of more than 50% of
excess body weight), 2 years following the primary bariatric surgery
even though you were compliant with a prescribed nutrition and exercise
program following the initial procedure.

The letter includes information on how to appeal this decision.

So, any idea's what to write back?

I paid for the mini sleeve only lost about 20 pounds.

Then got cancer and stuck at home gain weight back...also the mini sleeve was only a research operations.

Any help would be great!

Ok thanks,  

thanks so much for posting this!!!  this is great information and I didn't know this, I see so many posts for different insurance companies and questions, I now realize that those questions are moot.   I am going to get my document and check I was going to look into mexico but now I am going to check my benefits. 

I have seen so many post about can someone tell me if BCBS covers this or Aetna covers this or if Cigna covers this, oh yes mine covered it, oh no mine didnt etc.  you really have to understand asking this question this way will have no answer or at least the wrong answer.

1.  it is not your insurance carrier but your specific policy

2.  it is your responsibility to have and know what is in your subscriber agreement

3.  everyone should have an updated copy of their subscriber agreement, going in for bariatric surgery especially, revision or conversions double yes-wow the lamb going into slaughter wihout it

4.  A busy drs office will not be able to appeal everyone, they do this but it really is not their responsiblity is it the member's yes you.

5.  the insurance company will count on you not having a clue, and you not having and knowing your right via your subscriber agreement they surely are correct, you make it easy to deny you.

6.  you have to be proactive and not wait for others to do the work for you, you really have more power than you know, but ignorance is bliss.

7.  You agreed to that policy, when you have your annual enrollment, you should know what you are buying, ahhh buyer beware.

Now go out and make sure you know  what is in your subsciber agreement, then ask specific questions about your particular policy and how/why you are being denied, and know this BEFORE you even pre-cert for surgery,  you should know you will be denied or approved before your pre-cert goes out.  Ask the correct questions then you will get correct responses to your denials any other way will just be a waste of time.