balancingbilly

Surgery date 11/16. Start diet 11/2.

The peer to peer took a week. My doctor wasn’t very good about keeping me updated. I called Aetna and they updated me. At a month, I filed my own appeal. My doctor hadn’t even started the appeal after the peer to peer. My doctor said the Aetna rules were unique and took research to appeal.

I just went through this with Aetna. My peer to peer was denied. Eventually, I received approval. You can do your own appeal with Aetna simultaneously with the doctor.

I have completed everything. During my 3 months of Nut appointments, my weight fluctuated. I lost 3 lbs and I gained 3 lbs. My end weight was the same as my start weight. My net gain was 0. Aetna denied me because I gained weight. Once I lost the 3 lbs, I had to keep it off. In phone conversations they tell me it’s because I fluctuated, the denial letter says I gained weight. They Aetna reps also tell me it’s not a lost cause. These things usually get overturned on appeal. The peer to peer appeal was denied. The doctor is in the process of filing the second appeal. Aetna tells me I can resubmit my initial claim in October if the appeal is denied. I have no other appointments scheduled for nut, it seems like maybe I should... just for the weigh in. I am little nervous to call and ask though, because I have lost weight and I am afraid that I will gain a pound back and screw it up again. I knew Aetna had the one pound rule, but I was under the impression it was a net gain. Anyone had any experience with anything like this?

The peer to peer was denied, but I got sick of waiting for the doctor to do the written appeal. So I utilized my option to do my own appeal. Today I found out it worked. I have been approved. Just wanted to update this in case anyone else finds themselves in the same boat.