Denied By Aetna!!!

[Katiemak 0]

So upset I just found out I was denied!!! Going to try to appeal but wondering if I'm wasting my time?!?

[☠carolinagirl☠ 18,721]

why were you denied?

[amaral1407 11]

I was denied the first time with Aetna, first find out why where you denied. I was denied they said I did not satisfy the 3 month weight loss program they want; I was determined to get the surgery so I did the 6 months. My 2nd time the doctor submitted I was approved with 24 hours. Do not give up this is the best thing I could have done, stick with it!!!!

[Katiemak 0]

I'm not really sure...apparently they said my insurance does not cover the surgery. However, from day one I was told I would be fine with a comorbility. (sleep apnea). Now I don't understand what has changed or who to talk to!! My doc's office needs me to get my summarydescription plan to them so they can find the loop hole! Hmmmm! I don't know!!

[phxcwgrl2002 2]

Keep in mind it's not up to Aetna it's the way your plan is set up through your employer.

I just called them and that is what they told me anyways. If you read the exclusions from insurance which would mean it does not cover it. If it says lap band or any gastro not covered. they will not cover it at all.

Anyways, I just started this process I have a long road for me unless I paid for it myself.

[Katiemak 0]

Thanks for the help! My insurance is through my husbands work and I know a lady there got one done through her insurance. Just saying... I am hoping this will be resolved!!

[NWgirl 574]

Log on to your insurance website and look at the bariatric policy. Better yet, call the insurance customer service line and ask them the specific requirements for bariatric surgery and if your specific plan covers it or not.

If you did not find out this info in the beginning and relied on the Dr's office to tell you, it is very possible that the Dr's office got it wrong. There are so many variations of plans, and even if the initial plan covers it, employers can choose to cover or not cover certain aspects of a plan.

When I was originally looking at the band in mid 2011, I was told by the insurance coordinator of a very reputable surgery center that my insurance did cover WLS. I came to find out that it did not, and what had happened is that there were three separate insurance plans to choose from through the employer and the insurance coordinator ASSUMED I was on the plan that covered WLS without actually bothering to call and check. It was a big disappointment to me. Needless to say, I also chose a different practice when I knew it was covered this time around.

[Katiemak 0]

If that is the case then I am thoroughly disappointed in 1-800-get-thin!!! I have done everything they asked of me for 7 months!! I feel destroyed over this!! I will know more after reviewing my policy today!

[Tahneesamson 41]

If that is the case then I am thoroughly disappointed in 1-800-get-thin!!! I have done everything they asked of me for 7 months!! I feel destroyed over this!! I will know more after reviewing my policy today!

Isn't 1-800-get-thin the doctors that are being sued for all those deaths??!!! I watched it on 20/20 or dateline

[Katiemak 0]

Yes it is. Perhaps it's a blessing in disguise!

[ilikebunnies 48]

I watched it on 20/20 too and it scared me! I was reconsidering surgery after I watched that.

[Lollicatt 36]

I would definately find another place. I saw the 20/20 thing too and you want reputable doctors.

[honk 780]

Do not use GetThin. Call you insurance and find out what their requirements.

[phxcwgrl2002 2]

I watched that 20/20 as well but those Dr's are no longer in business because of it. I think that lady that died didn't tell the Dr's about her health condition. I think that is why it's so important to let the Dr's know so they do not run into complications.

@Everyone Thank you thank you for all your replies. I am glad I asked all the questions as they were coming to my head. lol.

I am trying be smart about all of this.

I like everyone tried every diet and it never work. I have been doing the Vitamins B12 and b6 shots, done Nurti-\System but that is loaded with Carbs and made me cramp really bad. It also has the food that is loaded with sodium. You would think if they were a good diet place they would make food good with low sodium and just bloated me to know end.

I am going to really think long and hard before spending all the money not like I have any. Maybe, the money tree outside my window. haha.

My mom on the other hand was very lucky she got the gastro bypass she lost over 200lbs and has kept it off since 2005. She is a whole new person. She got really sick like everyday. But she got past it. It took her like 3-8months but lost so much weight and never had to exercise.

She had to go do all the sleep disorders and all of what was required and the insurance paid the entire amount.

Me on the other hand, I don't never get that lucky. I have called the insurance already and they said they would not cover it. Maybe, it's a blessing in disguise.

I still have a long road ahead of me. It's either go pay for a gym and start over and just do my own diet might be cheaper lol.

Anyways, Thank you again for all of your replies, this gives me a lot to think about.

Time for bed Good night Lapband Family.....

It's nice to have new friends. :D

[NWgirl 574]

I watched that 20/20 as well but those Dr's are no longer in business because of it. I think that lady that died didn't tell the Dr's about her health condition. I think that is why it's so important to let the Dr's know so they do not run into complications.

@Everyone Thank you thank you for all your replies. I am glad I asked all the questions as they were coming to my head. lol.

I am trying be smart about all of this.

I like everyone tried every diet and it never work. I have been doing the Vitamins B12 and b6 shots, done Nurti-\System but that is loaded with Carbs and made me cramp really bad. It also has the food that is loaded with sodium. You would think if they were a good diet place they would make food good with low sodium and just bloated me to know end.

I am going to really think long and hard before spending all the money not like I have any. Maybe, the money tree outside my window. haha.

My mom on the other hand was very lucky she got the gastro bypass she lost over 200lbs and has kept it off since 2005. She is a whole new person. She got really sick like everyday. But she got past it. It took her like 3-8months but lost so much weight and never had to exercise.

She had to go do all the sleep disorders and all of what was required and the insurance paid the entire amount.

Me on the other hand, I don't never get that lucky. I have called the insurance already and they said they would not cover it. Maybe, it's a blessing in disguise.

I still have a long road ahead of me. It's either go pay for a gym and start over and just do my own diet might be cheaper lol.

Anyways, Thank you again for all of your replies, this gives me a lot to think about.

Time for bed Good night Lapband Family.....

It's nice to have new friends. :D

I also watched the 20/20 show. Those Dr's that are being sued are the ones that OWN all of the 1800-get thin, so they are still very much in business. In the 20/20, their own surgeons come out and say that they do not provide the best care for people. There have also been multiple people who have died under their care. If you choose to pursue with these Dr's, just be aware of these facts.

That sucks about insurance. I know you can find Dr's with a nice self pay price, if that's an option for you.