1.2 pounds cost me $9000, seriously, Aetna the reason

[lwmatch 31]

So with all the good advice and comments on my other topic, called Aetna tonight before going to Dr. tomorrow. Aetna flat pulled the rug out from under me. Their corporate policy with co- morbidities is 35 bmi or more. I was 34.8 so don't meet the criteria. Never mind surgery delayed from 7:30 a.m. till 5 p.m., not their fault. Agent with Aetna gave me her Supervisor voice mail, like I will ever get a call back. I guess I am s.o.l. Never mind I was preapproved and every weigh in including 2 week pre-op was fine. Any suggestions on what I can do? Other than accept it for what it is. So as harsh as it all is, the hospital was right and Aetna said if they had submitted that it would of been denied. Going to be a long 1 1/2 hour drive for my check up tomorrow. Thanks so much for listening and responding!

[cindyw41 761]

That sucks. No advise other than file an appeal with your insurance.. Take it to the head honcho.

[lwmatch 31]

I talked to Nurse administrator at the hospital, she was nice enough to call me after 8p.m. tonight to tell me she had contacted the Dr. to file. I was honest with her and said the lady I talked to THIS time at Aetna said it will be denied. I think this is the first step in being able to appeal is to get the denial letter in my hand.

[Sharon1964 2,530]

Yes, you're on the right track. You cannot appeal until you have a denial. On your appeal, you will stress that you were dehydrated and the weight they submitted was not your true weight.

Also, they could just approve and pay the claim, that's a possibility.

[lwmatch 31]

Yes, you're on the right track. You cannot appeal until you have a denial. On your appeal, you will stress that you were dehydrated and the weight they submitted was not your true weight.

Also, they could just approve and pay the claim, that's a possibility.

Thanks Sharon, another person on my other thread had made that same comment. Hopefully I will have a compassionate reviewer. Either way I have a life changing procedure I plan on making the most of.