The letter

[Bellanthin 112]

I've been denied by atena . I don't wanna give up I've been crying since may 21st <---------------- surgery date it just not fair ive been heavy all my life fear of dying at age 55 like my dad 10 years from now. I've been heavy all my life have bmi of 39.5 high cholestral high blood pressure I know there r people who have written letter and got approved I need help who do I write it to and a little help and ideia what people put in their letters.please and yes I'm begging for help here I have atena

[southernsoul 773]

Bella, I would think your surgeon's office might be able to help you figure out the appeal process & maybe how to word the letter. Even though they don't handle it themselves, they surely have had other patients who have to appeal an initial turndown & they may know what worked for those folks. I have Aetna also, but I was approved on the first request. I know Aetna has different plans, and I don't know what the differences are between them. Was there a reason listed for the denial? If they just said something general like "does not meet criteria" see if you can find out the specific issue(s) and go from there. Good luck!

[sueob1968 3]

Bella, I was denied 3 times by Aetna. I was so disappointed. I contacted LINDSTROM OBESITY ADVOCACY, and they got involved. After all appeals, it was approved by the independent review. They do charge for their services, but I believe they have an 80% win rate. I had made the decision to pay out of pocket, but ultimately I was approved. Kelley Brown Lindstrom was very helpful, and not pushy at all. It is something to consider. Hope this helps. I know how hard it is to be denied....

[Bellanthin 112]

Bella' date=' I was denied 3 times by Aetna. I was so disappointed. I contacted LINDSTROM OBESITY ADVOCACY, and they got involved. After all appeals, it was approved by the independent review. They do charge for their services, but I believe they have an 80% win rate. I had made the decision to pay out of pocket, but ultimately I was approved. Kelley Brown Lindstrom was very helpful, and not pushy at all. It is something to consider. Hope this helps. I know how hard it is to be denied....[/quote']

Ok. So I'm confused did atena finally pay or u payed outa pocket?

[sueob1968 3]

Bella, I am sorry, my response wasn't complete. I had decided to pay out of pocket as I had done everything required from Aetna. I did 'self pay' but kept working thru Lindstrom Advocacy, and after all appeals were denied, it went to an independent board, who approved it, so Aetna has to pay. I am now working with the surgeon and hospital, so they can submit the claims and I will be reimbursed. Apparently, they have 90 days from date of surgery to submit charges. I don't necessarily recommend risking it, but I needed to move forward on this. Either way, I had decided to have the surgery. I feel blessed that I will get my money back. I have about a month to get this resolved. All the billing offices have been helpful in submitting the claim now. If I can answer any questions, please let me know. It is so disappointing when you get a denial! For me, it was getting easier, when the 3rd denial came in. I had already convinced myself, I was making the right choice! I was elated when the independent board finally approved me. Don't give up if this is the right choice for you!

[Atlgadgetgrrl 6]

I will jump on the Lindstrom wagon here, too. I have United and was denied twice (initial submission and first appeal). My insurance required BMI of 40 and 5 years documentation of morbid obesity. I initially submitted at BMI of 38.3.

I got Lindstrom's office involved and they took over from there, and handled my case through my third and final appeal with my husband's employer since it was a self-funded insurance plan. I won. Even better, based on the thoroughness of the argument that Lindstrom's office put together, the medical director at my husband's company realized that their criteria was outdated and instructed United to change their criteria for WLS. So, hopefully, I have opened the door for others through my efforts.

I cannot say enough about Kelley. The experience was fantastic. I felt so much better even after our first call. They give a free consultation, and I recommend that you go ahead and get that scheduled because it will lift your spirits.

Best of luck on your journey. You can fight this and you can win.

[chinamama 104]

Go for the free consult. I also talked to Kelly, and instead of signing me right up she advised me to wait and let the dr do the peer to peer, then if I was denied again re-contact her. Well I was approved!

[Bellanthin 112]

Approvedd

[Bellanthin 112]

Approved

[Atlgadgetgrrl 6]

This is such fantastic news!!!!! Congratulations! I so love happy insurance endings!

[futureloser 190]

Good for you! You stuck up for yourself!

[sueob1968 3]

Awesome.....congrats....when is your date?

[Bellanthin 112]

thank u everyone i had to do an apppeal i wrote a letter ect it was a horrible ride being my origianal surgery was may 21 and was denined the day before surgery i called them today doctors dont even know yet they were closed when i called now have to get a new date.. in couldnt wait anylonger for letter in the mail

[Bellanthin 112]

Awesome.....congrats....when is your date?

i dont know yeti tried calling my program cordinater shes on vacaction so im guessing ill call her monday and hopefully she will be back and i can get my date