Question:
Has anybody had any luck appealing AETNA PPO?

I have been denied after my first appeal. I have not been on a physician approved diet in the past 2 years (Aetna changed their policy requiring this after I had already had my consult with dr. last July). I have been overweight all my life and have had 4 pregnancies in past 4 years. I would appreciate any help as to my next step since I really don't want to do a self-pay.    — Donna106 (posted on May 4, 2003)

May 4, 2003
You could try doing a supervised diet and then reapplying. Wish I had better advice for you!
   — [Deactivated Member]

May 4, 2003
I hired Walter Lindstrom and won my appeal with aetna ppo for not having a supervised Dr diet! I aplied to aetna Oct. 2002, denied Nov, then right away hired Walter, Paid $1100.00 to have it done in a hurry! We got another denial in Dec. Then Walter applied for an external review! I was then approved in Feb. 2003, my wls is in 7 days! May 13! I had not been to a Dr in 10 yrs prior to trying to get wls! When I was denied in Oct. I started my Dr supervised diet! So I was in the middle of my 4th mth of a supervised diet when I was approved! I did send aetna my TOPPS weight loss book, which had dates I weighted in and I had a personal dairy I had wrote everything I hate and weights for 4 mths the yr before. Now all this was before they required a supervised exercise plan and a nutrtionalist! Good Luck! Cyndi
   — CYNDI B.

May 4, 2003
If they just want 6 months of supervised dieting (which is what I think I've heard Aetna wants), you could probably get an appointment with your PCP, get put on a 'diet' and be done with the six months about as fast as you can get an attoryney and get the appeal done. Just make sure your PCP documents the 'diet' in your chart.
   — garw

May 5, 2003
Please go to my site here and read towards the bottom of the page. The external review doctor-which by the way, has to be a bariatric doctor seems only to be interested in the medical neccesity of the WLS. Aetna never saw my medical records-just the letter from my PCP. I sent in my own letter detailing all the weight loss attempts. It's a better chance for you to get to the external review process. I posted the entire letter of the dr.'s rationale for approving my WLS on June 10th!
   — toni S.