Question about Aetna

[Miss Piggy 30]

Working myself into a frenzy that I will get denied. I have 37ish BMI consistently for 8 years. No "official" comorbidities but a lot of other conditions that are related. I will have 3 letters from 3 doctors (PCP, surgeon & ortho) stating medical necessity. I have also written a heartfelt letter (although I doubt that will make a difference, lol). My final appointment will be on April 11th and the coordinator will send everything over after that for approval.

My question is... the Aetna bariatric surgery bulletin sets guidelines that I technically don't meet but I have seen other posters with a lower BMI get approved. I have heard some other posters say "it depends on your employer's plan". What exactly does that mean? Can the guidelines vary according to employer? Our plan is a PPO and we have amazing coverage. I have always been directed to the bulletin whenever I contact Aetna but I'm wondering if I should inquire with my husband's employer directly?

I'm just grasping at straws... the waiting and not knowing is torture

[brandyrn73 13]

I was in the exact same position with Aetna as you. I was denied. I'm now being told I have sleep apnea and my BMI has climbed to almost 40. I'm hoping with this information my appeal will go through and I'll be approved.

Good luck to you!

[0tracy0 6]

I was denied by Aetna about 2 weeks ago. My doc is doing a peer to peer review to see if she can get their decision overturned.

[0tracy0 6]

Peer to peer review was denied.

[brandyrn73 13]

I'm sorry to hear that! Do you have a plan B?

[0tracy0 6]

Honestly, I'm going to try a different surgeon.