Aetna can kiss...

Howdy, Well, it's a new year, and I'm on a new insurance plan. Aetna denied me in November because I didn't have sufficient documented diet history. My surgeon's insurance guru told me that they would appeal, but since Aetna was stopping coverage in January, the prospects were not good. My wife's office was in the middle of open enrollment for '05, so we started looking for a more WLS friendly ins company. I asked for reccomendations from Dr. Iqbal's office, and they told me that BCBS is pretty straightforward, requiring only a psych and nutritional consult. We ended up going with BCBS, although our insurance bill is $240 more per month now. Still, if they will cover the surgery it's worth it. Now for the slap in the face. My Primary sent an appeal letter to Aetna asking them to reconsider, based on the benefits of the surgery. On 12-15, Aetna reversed their decision, and approved me. I didn't find this out until about 12-28. I got the actual letter from Aetna on 1-3. I immediately called them to find out what this means and found out three things: 1) Because I changed insurance companies (completely due to Aetna's original denial of coverage) They will not cover the surgery now. I asked if I could switch back, and was told that I could not come back because I "jumped ship" (her words) 2) Even if I had stayed with Aetna, this approval (which is normally good for 90 days) expired on 1-1-05, due to Aetna's new policy excluding all WLS unless the employer purchases a "rider" to cover. Funny thing is, my wife's HR person received NO NOTICE of this change in policy. She told me if she would have known about the rider, she would have bought it, as there are several people in the company looking into the surgery. 3) Apparently Aetna is taking a little heat about this issue, and it's making the customer service reps a little testy. I have never been treated as rudely as I was by this phone rep. She basically told me she shouldn't even be talking to me since I "jumped ship" and was no longer an Aetna customer. She said several times that my weight issue was "my problem, not hers" and Aetna was sick of covering this "cosmetic, fad surgery" I am sure someone out there is going to sue Aetna over their refusal to cover this life-saving surgery. When that happens, if it goes class action, I want in. More than the increased costs to switch insurance, Aetna - supposedly in the business of making people healthier- has caused me a huge amount of anxiety and depression. As you all know, the decision to pursue this surgery is not taken lightly, and grief by some faceless company doesn't help. The good news is, I have completed my psych eval, and I am scheduled for nutritional on the 25th. My surgeon's office has told me they usually get BCBS approvals over the phone once the two consults are done. Pray for me as I continue this trek. Jeff Koon

Jeff, I was also rejected by AETna in December for the same reason. They also rejected the additional letter from my primaryBeing that there is no chance of me be able to change insurance companies anytime soon (and I was recently blessed with some disposable income), I paid for the surgery myself. I HATE AETNA. A few years ago, I had to fight with them to pay for my son's therapy. Like you, I want in on any class action against them! Good luck to you with your new insurance company. Let me know when you get the good news (your approval)! Natalynn

Jeff, i have heard their real bast---- so be glad your on with BCBS. Ithank God for my Qual Care PPO. I jsut found out I am approved whooohooo first time sent in and everthng! i pray all goes well with you and your wifes surgery. who is your doc? joyce

Im am so sick of insurance companies!!! I have used Aetna for years without a problem but how rude they have become! An insurance company told you that you couldnt come back?!?! Its our choice if we want to change insurance companies! Im not going to say anything else because I am fuming ...but I do want to wish you lots of luck with your new insurance and I pray for a speedy approval!! Keep us posted!! ~Kristin

GOOD LUCK WITH YOUR SURGERY. YOU'LL BE APPROVED. I HAVE BCBS AND WAS APPROVED SO FAST I DIDN'T EVEN HAVE TIME TO THINK ABOUT IT. AND I GOT APPROVED EVEN BEFORE THE NUTRITIONAL EVAL AND THE PSYCH EVAL. I HAVE HEARD NOTHING AT ALL GOOD ABOUT AETNA SINCE I'VE BECOME A MEMBER OF THIS SITE. AND IT'S REALLY ASHAME. AND FOR CUSTOMER SERVICE TO SPEAK TO YOU LIKE THAT IS ASHAME ALSO. YOU SHOULD HAVE DEMANDED TO SPEAK TO HER SUPERVISOR AND EVEN TAKEN IT FURTHER. I USED TO BE CUSTOMER SERVICE AND THEY'RE NOT SUPPOSED TO SPEAK TO PEOPLE LIKE THAT. ANYWAY, GOOD LUCK AND GOD BLESS.... SUE