How does an insurance co approve some and deny others?

I was in the library doing research and my question is how is it that the same insurance company that denied me flat within 3 days, with supervised attempts and co-morbs, approve others with no co-morbs or medically supervised attempts?? DO they just pick and choose depending on the mood they are in? MY surgeon has sent my appeal last week back to aetna ppo still havent heard anything..Does anyone have any ideas what the chances are having my denial overturned the second time around?

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