Second denial from Insurance

I have been denied a second time by Aetna. their biggest reason is because I didn't have a physician guided wieght loss program with weekly weigh in's the immediate past two years, YEP TWO YEARS not the 6 months a lot of you get by with. (this is because of my husband's employer) I have so many other co-morbidities... they do not count. oh here's the best part.... even if I would START as two year dr's weight loss program... it wouldn't do any good. they are DISALLOWING any weight loss surgery for any reson after Jan 1. ... I can not pay out of pocket ans we do not have the funds to hire an expensive lawyer to fight this. SO, GAME OVER I wish everyone here the best, be thankful if you have GOOD insurance I sure as hell don't. good bye and good luck to everyone

I am sooooo sorry...I truly understand what u are going thru. I have Aetna. I got denied the first time saying I needed six months blah blah blah so I went to PCP and dietician for diabetes and had everything documented. I still did not know if that was enought because every person I got at Aetna seemed to be a temporary employee and could not tell me hardly anything. I just prayed and tredged on...I found out Aetna is dropping it as of jan 1 too---but it depends on the employer. You should start with the insurance person and find out if they are excluding it. If not you still have a chance. Aetna isnt dropping it--to my understanding--its just that the employer needs to buy into a better policy to have WLS cover it. Whether or not that happens is why I refer u to the insurance person there. I am truly sorry..I promise you I know how u feel and it sucks especially when u need it so badly. Try those options......I hope and pray it works out for you....dont give up just yet! Hugs Lisa Durbin 12-15-04 Dr. Selwyn UC Physicians West Chester Ohio

Very sorry to hear this.

I am so sorry to hear that. I wish there was something that I could say or do to make it better. Your in our hearts and prayers. Cheryl

Deb, DON'T give up!!! File the next level appeal and also contact the state insurance department. Demand them to give you a hearing by an outside committee. Also, Aetna DOES NOT make you have weekly weigh-in's so if they told you that, they are incorrect. Make them show you, in print, WHERE it says that because it doesn't!!! Hang in there! Beth

Try getting another insurance during open enrollment? Best wishes......