Question:
DENIED

HAS ANY ONE BEEN DENIED WITH AETNA CHOICE POSII OF LA.WITH EXCLUSION POLICY    — msjackiej (posted on July 10, 2007)

July 10, 2007
so many people are complaning about the same thing.my ant has been denied 3 times. a little secret . constantly go to a dr, or nutrition for weitloss. the moore you go the better your chance is for aproval, if your unable to loose the weight on your onw. if you have proof such as a gym member ship, going to a dr, for weightloss, any weightloss program in the past submitt it and apeal it again. dont give up ok. get as many refearl from your dr, stating that this is medical nescary for you.
   — yvettetas

July 10, 2007
the ONLY solution is www.obesitylaw.com Walter and Kelly are absolutely the best advocates for ins approvals anywhere! I had been denied by aetna, appealed and denied and then I hired them to advocate for me....APPROVED!!! I started in Oct 06 and it is now 7/11/07...they approved me on June 29th but STILL have NOT sent the approval letter out! They plain suck!
   — LouAB

July 11, 2007
I have Aetna Choice POS II als and have been getting denied for a year and finally I got a call last friday that I am approved but waiting to get approval letter also, whatever you do don't give up and be persistant and amke sure you have all your "ducks in a row because they aren't going to give in easily. Good Luck
   — BETCBOO2

July 11, 2007
Sorry to be the party pooper here but if your policy has an EXCLUSION rider for weight loss surgery...then it is just that- EXCLUDED. You can fight it until you are blue in the face, but the reality is, an exclusion rider means coverage is excluded for a particular condition. It has nothing to do with medical necessity. I would say start saving your money or find another insurance company that covers the surgery. Good Luck
   — AmyinMA

July 12, 2007
Rather than waste another year of your life waiting for someone else to make the decision for you. Be come pro-active rather than re-active. Find out IF they EVER do approve you, what portion will they cover. Very few will ever cover more than 50% Which will still leave you with on the average of 12-15,000 being your out of pocket expense. Rather than fight a battle I would probably never win, I decided to see what other options I had with MY OUT OF POCKET EXPENSES. After all, If I was going to have to come up with this amout of $ I wanted a little more control, than them telling me how when where and what to do, and then just hand them a check for $15,000. (My half) Well the trend in insurance coverage is swinging to companies paying their employees cash to go have major medical proceedures out of the US. As the cost is a fraction of what it is going to cost them in medical expenses little alone the insurance premiums. If you can get a proceedure done out of the US for $10,000 including travel and everything that would cost upwards of $100,000. here in the states, financially it makes sense. So I did my own research and found more qualified surgeons out of the US and the cost was less than "My out of pocket expense here inthe states. Yes there were questions and concerns, but I did my homework and was more than 100% at peace with the decisions that I made in going to south San Diego (ie. Tiajuana) I had surgery 2-2-07, the medical facility was incredible. A brand new gorgeous hospital. Cleaner than any I have been to here in the states they were extremely attentive, New modern equipment (my brother is a maintence foreman in a hospital,and he was amazed at the quality of the equipment that they had at their disposal. Plus I got a quality surgeon who has been doing lap bands for over 6 yrs longer than they have been approved for here in the states. He does on the average of 4-6/day. and that is all that he does. Oh and by the way, he trains the US surgeons on how to do the lap-band proceedure. Whow would you want ....the masster or the student????Since my first fill on 3-15-07 I have lost a total of 105 lbs. That is 4 months that I could have spent getting upset and crying and hating life because i was DENIED again!!!! Remember insurance companies are in it for the profit, not for our personal well being. I am so grateful that I looked outside the box, or I would have still been traped in that box. I love life now, and cant wait to lose the other 100. Don't let someone else determine your destiny and happyness. Best of luck and if you have any questions or comments, please let me know. Also, all of my fills are free for life. all i have to do is get to mexico. guess what, it is cheaper to get a plane ticket, take a taxi to and from the border, to and from the hospital and back home again than it is for me to have a fill here at the "world class hospital that I have less than 1/2 mile from my door. Guess where I go. Viva Baja California!!!!!!!
   — mccabesmom