lisac82

Hi Everyone I just recieved my denial letter and the reason why I was denied was and I quote, "The information received does not indicate the presence of morbid obesity that has pesisted for at least 2 yrs, whiich can be defined as either (1) body mass index (BMI) exceeding 40 or (2) BMI greater than 35 with any of the following severe medical conditions....well my BMI this year was over forty however last year its highest was 37.20 and for 06 is 38.2. I do not have any other medical conditions besides my weight. So the reason that I was denied was that I did not meet the weigh requirement for 07. I lost and gained weight this is the story of my life. So now I dont know what to do or what can I do? I do not have money to self pay I was wondering if anyone was ever in this situation and had their decision overturned or can any one give me advice on what I can do? Thank You

Hi Everyone, I just found out that I am denied!!! My paper work was submitted last thursday 4/30 and I called my insurance company AETNA (I have EPO) and the rep told me I was denied because I was missing paper work, what???? My case worker sent my psych evaluation, dietition visits, my weight history, a personal letter from myself, and a letter of medical necessity. I asked what paper work I was missing and he was unable to tell me, he said I would recieve a letter. I don't know what to do it seems like my dreams have been crushed I dont have any money to self pay and I am going to appeal but I dont even know how that process works. Has anyone been denied for the same reason "missing paper work" ? Has anyone appealed? If so, what is the process? Please help I am not going to give up, I need this!!!!!!!!!

Hi Everyone, Well I have been on my lap band journey since the end of December. I did my three month required diet/exercise, nutritonist, and psych and so far I have been passing all test with flying colors. I lost fifteen pounds! yay :thumbup:I turned in my medical records last week and for 07 i have a bmi of 40 and for 06 I have a BMI of 38. The next step is submitting it to the insurance company (Aetna) and that is happening this week!! I am so nervous and I need your support please keep your fingers crossed for me or say a little prayer for me, I NEED to get approved, I NEED to change my life I am tired of being FAT. Thanks for your support, I will keep you guys posted

Congrats!!! I am waiting for my insurance approval to go through too and I have Aetna so I am hoping I have the same luck as you :thumbup:

HSJ Congrats!!! I am still waiting to find out, my case manager called and said they submitted on Thursday 4/30, so I am debating whether or not to call the insurance company, I am scared and nervous, what if they say denied, I would not be able to take that news but maybe I will get the courage I am hoping I hear something soon, how long did it take Aetna to decide?

I was wondering... what if your body rejects the lap band? (since it is a foreign object in your body) what are the chances of your body rejecting the lap band? What are the signs? Is there a time period after the lap band? Just wondering, if you know please fill me in Thanks :smile:

Hi Mzpotter I believe it is an HMO or as Aetna likes to call it EPo (sometimes I need a referal, sometimes I dont)

Ylissa, I have the same problem! and please fill me in if you get an answer. I finished my requirements but the only thing I am scared about is that in 07' my bmi is 38 and in 08' its 40 and I know Aetna requires a BMI of over 40 and Im nervous about them denying me. So let me know what happens, thanks