Question:
Has anyone has their denial overturned with AETNA PPO, after submitting

your own appeal letter, with your Surgeons appeal letter too?    — tylerswife (posted on October 20, 2001)

October 20, 2001
We would need more information. Why did they say they denied you ? Do you have an exclusion in your policy ? "Inadequate documentation" ? Your appeal really needs to address the reason for denial. ie, if they denied you because you didn't give them a 5 yr diet history and you and your PCP write a letter saying how much you need this surgery, they're still going to deny you until they get the information they need! If they only gave you a verbal denial and didn't say why, make sure you find out as it's very important! Good luck!
   — Anita N.

October 20, 2001
I did exactly that, I sent in my own letter and had the surgeon send one in also on appeal after my first letter was denied. Be sure to include your BMI and at least 2 doctor-supervised diets. If your BMI is less than 40, you must include co-morbidities too. I just used the appeal letter listed on this site and fit it to my situation. I had to be persistent though. Write down every time you talk to someone in member services and their name. Feel free to email me for more info.
   — sandieguy