Appealing Aetna

[UberBuffaloGal 20]

I was denied by Aetna and we very frustrated because the insurance said My sleep apnea was not severe enough to warrant surgery. With a BMI well over 40 for over two years, my surgeon believed it would be a simple peer to peer to explain the apnea was irrelevant. I was again denied. When I received my letter it stated my BMI had not been over 40 for two years. This baffled me, the insurance gave me dates of service when my bmi was 35-37 then 43, the following month. This didn't make sense to me as I know I have not lost any weight over the last few years. So I asked my doctors(gp) office to research. It turns out that there is another patient in the office with the same name and she is 5 inches taller. On two occasions they entered my height incorrectly! I am hoping with the new information, my appeal will go though. I am posting because I was ready to give up. I may still be denied, but not without a fight. Thank you everyone who told me to fight, question, and keep calling (insurance and docs office)till I get someone who will help.

[SoPeachy28 53]

UberBuffaloGal you have to keep fighting. You have come too far to stop fighting and god forbid they deny you again, keep appealing til they get sick and tired of you and approve you. I work at a hospital and that's who my insurance is through I had a friend who had gastric bypass surgery last July and Aetna didn't give her any issues. She had no co-morbidities just a high BMI. And she was approved so quickly. My nutritionist told me that Aetna has gotten more strict lately. But I don't care how strict they are they listed guidelines and we have followed them and do what they have asked of us and now they're giving us a hard time!! They SUCK when it comes to Bariatric Surgery!!!