It's official......denied

Hello AMOS family Well, today I received the official denial letter. Aetna denied my pre-certification as I need to complete a 3 month doctor supervised nutrition and exercise program. In anticipation of a denial, I started my program on 3/21 with my PCP, 3/23 with the nutritionist and 3/30 with exercise program. So I actually have two months left with anticipated surgery in June/July. Keeping you in my thoughts and prayers. Brenda

Brenda, Every day is one day closer! At least they will pay for it after that. Some get denied totally. Remember mine was denied a year ago even after appeals. It wasn't until I switched insurance companies did I get approved. You are steadfast in your goal. Keep at it. Time will slip away and before you know it, day of surgery will be here!!! Terri

Terri: Thanks for your words of encouragement. I am lucky that they did accept my 3 month program from 2003, but they want something closer to the surgery date. I sure do hope the time flies by. It should since the weather is getting warmer. Keeping you in my thoughts and prayers. Brenda

Brenda, I am so sorry to hear that you were denied. Make 'em pay for their denial decision. I will email you later on. Just wanted to say sorry that you were denied. Sara

Sara: Thanks for your caring. I will talk with you later. At least, I have only two months left. Keeping you in my thoughts and prayers. Brenda

if this is something that you want never never ever ever give up there are agencys out there that can help you thru your appeals and what not.... just remember you are worth the fight Stacy

Stacy: Thanks for your encouraging words. I will not give up. I am not going to appeal right now. I am going to finish my 3 months of supervised nutrition and exercise and then re-submit. If they deny me again, then I will appeal as they told my doctor's office that I need only 3 more months. Keeping you in my thoughts and prayers. Brenda

Hiya Brenda, I was originally denied by Aetna for the same reason. My surgery was scheduled originally for 9/21/04 (I think, lol) but got the denial in early august as I did not have the required 6 months of dr. supervised diet (I was shooting for the 3 month of dr supervised diet and exercise but my dr had not been supervising my exercise) so I just went back to the dr in august, sept, and oct and turned in all my evidence by fax and was approved by the end of october for my surgery date of 11/11/04. My suggestion for you would be to ask the doctor for copies of his notes each time you visit (he must give them to you if you ask for them), and at the end of the three months, write a letter to Aetna stating you now have the required 3 months of dr supervised diet and exercise and fax it along with the copy of their denial letter (just in case they "forgot" why they denied you and dont come up with some other lame excuse) and a copy of the doctors notes. Also keep a copy of everything just in case it all gets "lost". It will all work out - this is just a temporary set back!! God bless you and keep you, ~Andrea 223/151/125

Andrea: Hi. Thanks for your kind words. I believe Aetna is just being a pain in my case as someone at Dresser-Rand forgot to include my husband in the list of eligible retirees they sent to Ingersoll-Rand back in November 2004. Therefore, we paid our deductibles and co-pays to BC/BS and when the error was discovered, Aetna had to allow those payments as being paid. I think this is their way of getting even. Thankfully, I had 3 months within the past 2 years which they accepted. I have completed appointments this month, so now I have to do April and May. They want something closer to surgery date. I will get a copy of the PCP's notes, the nutritionist's notes and the exercise notes for my records. I will have copies of all reports sent to my surgeon who will deal with the insurance company. He and his staff are absolutely wonderful. They are use to dealing with all kinds of problems. Congratulations on your wonderful weight loss!! Keeping you in my thoughts and prayers. Brenda

Brenda, Hun I am sorry that you were denied.... That is good that you have it under way with the remaining 3 months...... It will go really quick hun, my 6 months did but this waiting for the LAST weigh in and my surgeon appt is killing me..... At least before it was just the monthly weigh in's....... Well I wish you luck hun and maybe we will have surgery around the same time...... Take care Debra