Aetna said "NO!" - HELP!!!

[Denise H. 0]

I have just received my first denial from Aetna PPO. They said they need documented evidence that proves I have been overweight for the last 5 years and that I have tried to lose weight from a doctor in the past. I have evidence from a doctor that I was trying to lose weight by taking Phentermine - does anyone know if that qualifies/helps? What would be good to submit to Aetna to appeal this? Please help I do NOT want to give up!!!! Thank you so much!!!!!!

[Thinjen 0]

I have Blue Cross/Blue Shield in Tennessee and they denied me too. They wanted to see that I've been fat for 5 years. I can show them 33 years worth. Anyway, maybe documentation from ob/gyn visits for the last 5 years will do for the 5 year thing. My company also wanted 6 months supervised diet with my doctor. I just finished that. I kept a food journal and my doc scanned it in. Gained some, lost some....such is life. We just resubmitted to BC/BS...so we'll see. I think most of them tell you no in the beginning just to weed out some folks that aren't willing to pursue it. Good luck to you. A healthy you is worth the hassle.

[Guest self_payor]

Thinjen - why would your company want evidence of six months of dieting? What do they care? Just curious.

[SherryW 4]

Insurance companies sometimes request the 6 months of prior diet attempts to prove you CAN'T do it with diet alone. I've had years of attempts and yes your doctors weight in records would help you. If you've gone often enough, like me I had to go every 6 months because of my bloodpressure, then you'd certainly have proof.

[Guest self_payor]

:doh: nevermind my post. I thought it was the employer wanting the 6 months diet record and not the insurance company.

[Ceparano 0]

Thinjen - why would your company want evidence of six months of dieting? What do they care? Just curious.

I am going through the same thing with GHI. They require this as proof that you have actually tried with a doctors help. I agree it makes no sense, and is sooooo frustrating!!! I'm 3 months in and this waiting is killing me. April can not come fast enough. Don't give up your Quest for good health no matter what hoops they make you jump through. Hang in there.

[Alexandra 55]

Denise, this is just one of the requirements that MANY carriers have. It's not a "no," it's a "we don't have enough information yet."

DON'T GIVE UP!!! Worst-case scenario, you start a six-month relationship with your PCP tomorrow. If you've been seeing doctors over the last few years for ANY reason, get their notes. It's possible/likely that their notes include comments on your weight.

I had Aetna too, and what I supplied was notes from my OB/GYN from the two deliveries of my children, which had happened within the prior five years. So there were lots of notes on my weight, even if they didn't involve attempts at weight loss. And in 18 months prior to banding, I'd been seeing my PCP regularly to talk about weight loss, surgery, my thyroid, etc., and all of those notes counted as well.

This is a minor hurdle. Historical records from any doctor will do to support the five-year-history requirement. And if you can't supply the six-month diet attempt, get started NOW. Six months will go by before you know it.

[Denise H. 0]

Thanks Alexandra and everyone else!

It's reassuring to know that there is someone out there that has dealth with Aetna!! I am upset about all this and to top things off my Dr told me today that Aetna will not pay for it (her own words!). It's not very encouraging to have your Dr's office give up on you......

[Alexandra 55]

Denise, my doctors' office was totally sure I'd lose, too. But I won, and they had to eat their words. All they have to do for you is submit the request--you'll handle any appeals. Don't give up! This is OUR health at stake, so we should never let the carriers make our decisions for us.

[ReneBean 3]

The Six Month Diet thing is just so the docs can be sure that Surgery isn't your FIRST attempt to lose weight. Now, almost everyone who is overweight has SOME history of dieting - so even if you don't have the Doctor Supervised thing - you can always point out a life-time of history.

Nice of your Doc to be so encouraging - but, I guess they have to deal with reality - and sometimes, the reality is bleak.

Get whatever information the company wants and get the package re-submitted. I had to fight Blue Cross of CA all the way to the State Insurance Board - but I got my approval.

Don't give up. Every time we win, we make it easier for the next person - not to mention getting coverage for ourselves.

Hugs!!

:]

[rroswelltx 1]

I am awaiting now my answer from Aetna. I turned in so much documentation it wasn't funny! I am just praying that it will be the right answer.

Rene, I am going to Dr. Fox too.

[feleciaj1 0]

I have just received my first denial from Aetna PPO. They said they need documented evidence that proves I have been overweight for the last 5 years and that I have tried to lose weight from a doctor in the past. I have evidence from a doctor that I was trying to lose weight by taking Phentermine - does anyone know if that qualifies/helps? What would be good to submit to Aetna to appeal this? Please help I do NOT want to give up!!!! Thank you so much!!!!!!

In my 5 year history my doctor's office included any weight that I lost and gained back using diet pills, any weight loss programs like Richard Simmons, Slim Fast, Jenny Craig all that counts. And when you went to the doctor if they have ever told you that you needed to lose weight.

[Thinjen 0]

Update...Blue Cross/Blue Shield said no again. They are the DEVIL. I'm fighting them. They shouldn't mess with a depressed agoraphobic, what else do I have to do, but fight?

[Dody 0]

Phentermine came along before the dredded phen-fen. It is a dirivative of it. Dangerous to say the least. I know I took it and had a heart attack on it. Lucky you came thought it alright. If you have a good family physician they are usually willing to document that you have constantly tried to lose weight while under their care, especially if you have been with them for years and they know of your battle. Meridia is counted, and I have no clue why, because it is the absolute worse diet pill ever invented. Talk to your family dr. and see if you can get a letter that you have battled weight issues under his/her care. My dr. did it for me willingly.