Question:
Still trying to get approval from Aetna, PPO. 3rd Appeal.

I have been trying for apporoval from Aenta since July, 2002. This will be my 3rd appeal. Has anyone else had this experience? Thanks, Pamela.    — pamela1 (posted on January 7, 2003)

January 7, 2003
Pamela, I have Aetna PPO too, but was approved... If you want to email me, we may be able to discuss a few things that worked for me. I was approved the first try... Write if you want to talk. -- Tricia
   — Tricia C.

January 8, 2003
Hi Pamela - Sorry to hear of your dilemma. Do you know the particular reason why Aetna PPO wont approve? I have Aetna PPO and was approved right away (I know you probably hate to hear that...) but when my surgeon's office manager submitted my papers, she told me "they HAVE to approve - you meet all their criteria". Aetna even has their policy on WLS posted on their website... So try to determine what the sticking point is and address it. No documented diet history? - get one!... have you had a sleep study? - get one! I didn't think I had apnea - turns out mine is 'severe'! Good luck - some people just seem to have harder times than others. Best wishes, Nancy
   — Nancy K.

January 8, 2003
I also have Aetna, but I don't think my plan is PPO. Not sure. Anyway, I was also approved on the first try. Are you sure your employer (or your spouse's employer) doesn't have a clause eliminating WLS? Is Aetna giving you a reason for the rejections? Good luck!
   — Yolanda J.

January 8, 2003
Hi Pamela, I have Aetna PPO to. I am on my first appeal. I don't understand it either when some people are approved right away, and here you and I are having to appeal it. You didn't say what reason they gave you for denial. Mine said that there was no official code for laporoscopic bariatric surgery. I was also told there was no reason I should have been denied, and that we should appeal and use just the code for bariatric surgery. Anyway, we sent the letter 11/20/02, and they just acknowledged receiving in 12/24/02, and said that they will review and get back to us in 30 days. Who knows what their deal is! Good Luck! -Autumn
   — autumn F.