Question:
Ive been denied by aetna hmo and need help in writing an appeal...

MY BMI IS 44, BUT I DID NOT HAVE ENOUGH PROOF OF DOCTOR AUTHORIZED DIETS, SINCE TWO OF THE THREE DOCTORS IVE HAD DIETS WITH THE LAST SIX YEARS CONVIENTLY LOST MY MEDICAL RECORDS SO MY INSURANCE DENIED MY REQUEST,FINDING THE SURGERY NOT MEDICALLY NECESSARY?? THE NURSE WITH MY INSURANCE COMPANY SAID I COULD APPEAL BY WRITING A LETTER TO THE INSURANCE COMPANY IN MY OWN WORDS. I JUST DONT HAVE A CLUE WHAT IM SUPPOSED TO BE SAYING. I ALREADY WROTE THEM A LETTER STATING PROBLEMS WITH BEING OVERWEIGHT ETC.., AND THEY STILL DENIED ME!! NEED ANY INFORMATION YOU COULD GIVE. IM NOT GOING DOWN WITHOUT A FIGHT. THANKS    — shauna S. (posted on December 17, 2001)

December 28, 2001
I know this is a little late, but in case you are still looking, Id like to offer some words of advice. Ive never written an appeal, but I do have some background knowledge about Aetna HMO. The approved me with a BMI of 42. All I did was list two encounter I have had with Doctors regarding my weight. Appearently, they didnt check up on it because I know for a fact that one of my doctors lost my info a long time ago. All you need is to show them that you have a BMI over 40 and have had at least two medically supervised diets. If the doctors you saw are still practicing and remember you, you should ask them for some kind of written statement from them as proof to Aetna. Sometimes you have to push, but not too too hard to get what you want from them. (Aetna I mean)I work for them so I know this for a fact. The people reviewing your case dont want to deny you but they have to go by the letter of what you policy states. So be nice but be persistent. Sometimes I think your best bet is finding a doctor that has a good working relationship with your insurance company. I wish you the best of luck.
   — [Anonymous]