Question:
Anyone been denied over & over by Ins Co.? (Aetna PPO, denied me 1x)

Has anyone been denied over and over by an insurenace company? Especially Aetna PPO. I have been in this process since October 2002. I was denied today December 20, 2002. This is a little discouraging. I know I'm going to keep fighting for this but I just want to know what others did in different cases. Thanks guys!!! Happy Holidays! *_*    — Dayanara A. (posted on December 20, 2002)

December 20, 2002
From what I have read, insurance companies usually deny people the first submission. Check this web site out for a few clues and some letters to submit at the bottom. You can take it all the way to your state insurance commission if you wish. http://www.insure.com/health/obesity.html
   — Jon S.

December 20, 2002
I have Aetna POS and they denied me the first go around. They approved me after I appealed. Don't give up. It took me almost 6 months to get my surgery. It is not an overnight thing.
   — imaginec

December 20, 2002
I'm interested in following your case since I too am a Atena PPO member. I have just started my process. I hope it goes well for you. E-mail me if you want to. Janine, [email protected]
   — Janine W.

December 20, 2002
i was denied twice by aetna ppo,simply because i had no dr. supervised diet on record.even though i have been off and on diets for some 16+ years.. i am very lucky though,because my husbands company is actually self insured so aetna is only an agent..i was able to appeal directly to my husbands insurance dept. and 2 months later i am approved!! keep fighting!! why did they deny?? if it is because no 6 month dr. diet,i would do it.go and be weighed once a month by dr. and then try again.. best of luck to you.. happy holidays... jeanne/ca... lap rny 1-16-03.. :>
   — jjettrox

December 20, 2002
Hi... Don't give up...many will deny you first time but you must be diligent, persistent and don't back away. Find out specifically why you were denied. File an appeal to include a good letter of why you need this surgery based on health, now inability to function in some areas if that is so, what your future may be like with this surgery and what it will be like if you do not have it and continue on this course. Include letters of medical necessity from your physicians and photos if possible. Let them put a face with the need. My best to you. I am now 8.5 months post op and down 96 pounds and feeling super and I was denied twice. I then went to HR of my husband's company and within 2 days it was turned around. Here's to a healthy 2003.
   — AJC750

December 23, 2002
Hi! I too started this in October 2002. I received my first denial in November. I am also Aetna PPO. All I can say is keep fighting. They told me that they do cover baratric surgery, but that we just need to change the code, because there's no specific code for laporoscopic surgery. I sent in my appeal, and I'm still waiting to hear back from them. Good Luck to you! - Autumn
   — autumn F.

December 23, 2002
Hey There... DONT GIVE UP!! I was approved by Aetna (ppo)the first time around. You need to meet their criteria and have it documented. Have your PCP write a letter saying that you have been MO for 5 years and have tried several diets (make sure at least one was doc supervised and that you have made diet attempts in the past 2 years with at least one lasting 6 months. My doc did this for me and it was no problem. KEEP ON THEM!!!!!! Get the name of the person who is handling your appeal and their direct line (ext)and fax line. You will be fine, just be diligent with your efforts! Good Luck and Happy Holidays! :-)
   — Pizofret

February 21, 2003
Hi this is Dayanara, I just wanted to thank all of you who gave me some answers. I was denied late Dec. Appealed in Jan. Approved in Feb. surgery will be Mar 12.! *_*
   — Dayanara A.