AETNA DENIAL TWICE

[amaral1407 11]

Okay it been an emotional 2 weeks Aetna has denied my surgery twice due to not having proper documentation to do the 3 month multidisciplinary plan. Anyone have a copy of exactly what the doctor has to put on his paperwork every month. I have given up on the 3 month and am just hoping to get approved on the 6th month.... Any help or suggestions would be greatly appreciated. Don't think I can handle a 3rd denial...

July 8- primary care

Aug 5- primary care

Aug 5- nutritionist

Aug 19-nutritionist

Sep 2- nutritionist

Sept 9- primary care

Sept-30 nutritionist

Oct 7-primary care

Oct 21- nutritionist

I have been going to curves twice a week and walking treadmill twice a week. Done all my pre-surgery testing;

Thank you...

[shaah 0]

Okay it been an emotional 2 weeks Aetna has denied my surgery twice due to not having proper documentation to do the 3 month multidisciplinary plan. Anyone have a copy of exactly what the doctor has to put on his paperwork every month. I have given up on the 3 month and am just hoping to get approved on the 6th month.... Any help or suggestions would be greatly appreciated. Don't think I can handle a 3rd denial...

July 8- primary care

Aug 5- primary care

Aug 5- nutritionist

Aug 19-nutritionist

Sep 2- nutritionist

Sept 9- primary care

Sept-30 nutritionist

Oct 7-primary care

Oct 21- nutritionist

I have been going to curves twice a week and walking treadmill twice a week. Done all my pre-surgery testing;

Thank you...

Hang in there, you have come this far. i have Aetna also and just got my date but i know I still have to be approved. i was told 6 months but if i see my nutritionist more than once, i will probably only have to wait 3 months. i prepared myself for the 6 month wait but i would love for it to happen in january. i have followed your journey and everytime you get let down, i worry but then i see you get up and keep pushing, so dont stop now.

[amaral1407 11]

Thank you I 'm not stopping now. I have been documenting all my exercising. Made my appointment for my month PCP and asking for a letter stating why the surgery is necessary with my co-morbidities, also, have an appointment this friday for the nutritionist. Figured it better to be safe this time. I wish you luck also.

[amaral1407 11]

Okay everyone keep their fingers crossed for me. I did the 6 month diet and now it was resubmitted to Aetna on Thursday for approval. Everything looks like it should be in order this time I hope. Don't think I can take a 3rd rejection.

[jennxaz 6]

I had aetna. I did 3 months supervised diet. I heard they are very strict about going exact time every month

You can double check aetna's requirements by going to the website its layed out there for you.

below is my timeline.

Oct 25 nutrionist/blood work

Nove 25 nutrionist/psych

decemb 26 nutrionist/chest xray

january 25 nutionist/pcp approval

january 26 egd

january 31 approved

february 16 surgery date

[cunner 21]

They should have clearly outlined in the denial what the reason was for denial. With that said I have Aetna and was denied as well. I was denied thoughout the entire appeals process. The final step after exhausting all appeals though the insurance company is to request an idependeant external review process. I contacted Kelley Brown Lindstrom at obesitylaw.com on a recommendation from someone on this site. She and her husband Walter are AWESOME !! They handled every appeal and finally the external review process. My claim was overturned in the external review and Aetna was required to cover the procedure.

Believe me I know the frustration and disappointment that comes with every denial letter. I lived this for OVER a year. I got my approval 1 day before my family vacation to Disney World in October 2010. My surgery was 12/28/2010. At this point I am almost 14 months post surgery and couldnt be happier with the weight loss. I am at 182 which is only 7 pounds above my goal weight.

A little over a year ago I couldnt do a lap around the track without feeling like I was going to die. Since then I have run several 5K races with time under 25 minutes. I play hockey a couple times a week and I am training for a half marathon in May.

Please dont let those denials discourage you. I know how bad they made me feel. I think I got a total of 5 of them over a 10 month period. Check out obesitylaw.com web site too. It cost me exactly $0 for all of their help. Did I say that Kelley is the BEST. After every denial she was so encouraging. She assured me that it was OK. That is what they wanted in my case. They had to get away from the reviewers in Aetna and get to the external review. I'm sure every case is differnt but again please hang in there. It is so worth the fight.

[amaral1407 11]

APPROVED FINALLY......Such a great day !!!!! Now just waiting for the Dr. to look at all my paperwork and schedule surgery... Hoping for the first part of March. So glad I stuck with the process...

[Cocoabean 430]

Awesome! Congratulations!

Cunner, I remember when you were going through the appeal process! Congrats on your successes!