Question:
Insurance denial

HELP!!! My Dr. sumitted all necessary information to my Insurance carrier Aetna Open Access, and my first letter was denied, due to insuffecient diet history....before I started this process I talked to a supervisor with agency and she told me that having 2 yrs of LA Weight Loss would work as diet history...so my Dr. sumitted additional information they wanted and I was recently denied again due to insuffecient diet history....does anyone have any suggestions on what I can do?...I have 60 days to do another appeal.    — beckycrossin (posted on January 11, 2006)

January 11, 2006
if you ask Aetna to explain them selves 3x you will get 3 different answers, "your surgeon should know, your PCP should know, or go to cbt 0157, which you really should, its educational document ,via the aetna member page,read the whole thing,carefully, so u can quote it back to them when they fail to follow thier own rules
   — walter A.

January 11, 2006
I was approved through Aetna POS within 24 hours. If you would like I can send you my letters that I used to get approved.
   — *Malena* M.

January 11, 2006
I had this same problem with a different insurance company. I had been taking diet pills prescribed by the doctor for two years and even though it was in the doctors notes they kept denying me until I got a prescription history from my pharmacy and sent it to them. So maybe all you need is something from LA Weightloss stating that you had attended for two years. Hope this helps and good luck!
   — tdickson

January 11, 2006
I have the same insurance, and they have to have a DOCTOR _ DOC:UMENTED plan. You have to have been under a medically supervised diet, not just a weight loss program. Go to your doctor, get a diet plan, and go once month for weigh-ins. then resubmit. that will probably take less time and be easier than fighting with them. Set your surgery date for seven months from now, and you should be all set. You also need to prove your comorbidities, so meanwhile get a sleep study with a pulmonologist, get a psych evaluation, and get a cardiologist workup. Get all your ducks in a row, then you can get approval.
   — Novashannon