Denied

[dede0314 356]

I have Aetna and called today and my level one appeal has been denied. I did the 3 month program and gained 9 pounds during the process and was initially denied because of that. I did and extra 3 months and lost 16 pounds and was down 3 pounds from my initial weight and I called them today and they have decided to uphold their initial denial. I am going to hire Lindstrom to do the second level appeal if I get denied again I will do the external review. If the external review is denied I'm planning on going to Mexico.

I'm so upset I just want to cry but I won't give up.

[bvenegas 89]

Yes cry but dont give up!

I also am rejected but due to an error (which is being corrected) I have to stay positive that it will go through. I tell my self there is no other choice.

We'll be fine one way or another. this is just a set back. Once we are sleeved it will have that much more meaning becuase of the struggles just like anything else.

[dede0314 356]

@@bvenegas Good luck and keep me posted on your progress.

[Sharon1964 2,530]

For what specific reason did they uphold the initial denial? Get it in writing, and also get a written copy of their requirements for bariatric surgery. If you meet the requirements, you have a very good case to get it overturned.

[dede0314 356]

When I spoke to the representative she said the notes said that I gained weight even though I lost all the weight I gained. I still haven't gotten the official denial letter in the mail.

[momma_missie 30]

*hugs* Can't imagine roller coaster you are on. Stay strong and focused... keep your eye on the prize and you'll get there!! Good luck as you move forward with an additional appeal.

[dede0314 356]

@@momma_missie Thank you!!

[nurseforlapband 11]

As long as you are the same weight or less than initial weight, you should have been approved. I suggest calling aetna and ask for a case manager. They can give you a better explanation and even get the decision changed. I had a similar issue. They denied me because of the facility and after talking to case manager, she helped me get approved.

[bvenegas 89]

Finally approved after 2nd well I should say 3rd try. Schedule for June 1

[dede0314 356]

Finally approved after 2nd well I should say 3rd try. Schedule for June 1

Congrats.... I'm trying to get everything ready for a second level appeal... Hoping that goes well

Edited May 21, 2015 by dede0314