Question:
Has anyone been denied, Then go through the department of insurance?

I was denied coverage with Aetna, then given the option of doing a independent external reveiw, through the Az department of insurance. I said, yes. So now my records have been forwarded there. Now i wait again,And hope they overturn Aetnas decision. Has anybody else gone through this? If so, can you tell me how it turned out? I am completly new to all of this. But I'm learning fast. Thankyou RoChelle potter    — ravpotter (posted on July 10, 2003)

July 10, 2003
I went through this process in CA -- I was denied on a 2-1 split decision, but probably for a different reason. Aetna approved me for the RNY on my first request, but I had requested the DS! I appealed all the way through Aetna's internal procedures, then to the CA Dept. of Insurance -- one doctor said the denial of the DS should be overturned, two said no, it should be upheld -- but one of those two said, "although the DS is no longer considered experimental ..." he didn't think I proved it would be BETTER for me than the RNY. At that point, I finally got hold of an attorney at Aetna and told her I was going to sue, and anyway, the one doctor said it was not experimental -- and to my astonishment, she agreed, and I was approved a few days later! If the reason you're not approved, however, is that you didn't meet their requirements, I don't know how going to the DoI is going to help you -- unless it is that you don't have the required diet, etc., within 2 years and your argument is that it is pointless and hazardous to your health to make you do this when it is a PROVEN SCIENTIFIC FACT that people our size can't lose weight and keep it off without surgery! In that case, maybe someone will listen. Good luck! Diana
   — [Deactivated Member]

July 11, 2003
I just wanted to tell Diana, I like your style! heehee
   — Leslie F.