Question:
How many denials before Aetna approve

Hellow everyone, I just recieved my second denial letter last week, from Aetna I have completed a 6 month program through Neweigh in houston and they still are saying no. ...please help !!!    — domino1123 (posted on August 17, 2006)

August 17, 2006
I really feel for you. I have AETNA and they denied me at first. I was hysterical, felt like this surgery was my last hope and it has been taken away from me. What helped me was I spoke to the HR person at my husbands work (he is my primary insurance) and she called her rep at Aetna and then it was reversed!! SO CALL YOUR HR PERSON AND HAVE THEM HELP YOU. Please email me if you have any questions, I know how lost you are feeling now. By the way, Im 5 months post op now!!
   — jomamma

August 17, 2006
I have Aetna and was approved first time. What reasons are they giving for your denials? Do you have a written copy of everything they are requesting? I did blood work, EKG, psych eval, 6 month supervised diet (must be continuous, every month, must weigh every time, PCP must document your progress and what you talk about), physical check up with nurse practictioner, lung x-ray...I think that's it...sorry, can't remember. Your surgeons office should be helping you with this. I did nothing - my doc's office handled everything. I'm sorry you're going this - don't give up! Ask your surgeon's office for help. Good luck!
   — platypus

August 17, 2006
My GP called the medical director for Aetna for my area and had it out with him. After a 30 minute phone conversation, I was approved. Unfortuately, not all GP's will do that for a patient. I was told by my insurance broker that each year as the new plans come out they are making it harder and harder to get approval.
   — WMKaisla

August 18, 2006
I also have Aetna PPO. id you get their clinical guidelines for gastric bypass and follow them exactly? You need a ltter from your physician with documented weigh-ins every month for six moths. You need to see a nutritionist. You also need to have your comorbidities documented. (sleep apnea, high blood pressure, diabetes, etc). Then you need a psychological evaluation. I also had blood work and a letter from my surgeon, as wwell as my own letter detailing the problems , physical and psychological, that I underwent from my obesity. Finally, does your BMI meet eh level required? If you have all that, I don't know what to tell you except to keep trying. If you don't, then get it.
   — Novashannon

August 20, 2006
I am 2weeks out.I had my WLS aug 10,2006. Dr Kodali is my Dr. and I also go to Neweigh. I also have Aetna but I have the (HMO) version. I too was denied 2 times, Neweigh has everyting under control, just sit back and relax they will fight this thing for you.They will handel Aetna for you, just be encouraged,get your bag packed, and start your after surgery shopong for all your vitiams, protien shakes. Good luck see you on the other side!!!!!keep your head up, dont give up dont give in.Get ready, get ready, get ready.
   — newbegining