Aetna ***

[emme.vee 142]

I will never again complain about my insurance. I'm sorry that you have to go thru all this guys.

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[KristenLe 5,979]

Received message with the net weight gain photo but doing more research and found out by talking with dr office today and they said I did not gain , I actually lost weight start 6/2015 240lb to 9/2015 at 239.5 so I'm not sure what is going on. Maybe Bec The dr office submitted my paperwork to insurance comp two weeks after the 6 month deadline to schedule my surgery , I have no idea.

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This is BS! Anything to avoid paying! Fight!

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[dede0314 356]

What exactly did your denial letter say?

[aslcertified 86]

Yes I will fight.

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I hired lindstrom advocacy and they are fighting with this with me

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[dede0314 356]

I also used lindstrom. Had to go through to the external appeal but won in the end. Don't give up

[aslcertified 86]

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I hope you can read it !

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@@dede0314 thank you.

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@@KristenLe thanks

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[aslcertified 86]

Oh and by the way , Aetna (case manager) said I am only allowed one level appeal and external review is not allowed under my plan

So I did a little digging and pulled up my benefits and researched , then called Aetna and was told a different story.

I am allowed an external appeal and my denial letter indicate that I am allowed not only one but two appeals plus an external review. This is unbelievable !!!!

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[aslcertified 86]

Insurance companies expect your monthly premiums on time but they surely put you through hell to have them pay for something that is covered under your benefit plan.

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[SouthernSpinoza 2]

Wow! My doctor's office told me that with Aetna weight gain is a huge deal. Even half a pound would get you denied. I was recently told that the time frame is a huge deal too. I was told I had to schedule appts 31-35 days apart, including weekends. If you go out of those date ranges, they will require you to do the 6 months instead of 3.

On another forum, I saw where a lady gained and Aetna didn't deny or approve her, they just made her do an extra 2 months and she had to lose weight, not gain or maintain.

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[SouthernSpinoza 2]

ImageUploadedByBariatricPal1469662552.370969.jpg

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I hope you can read it !

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@@dede0314 thank you.

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@@KristenLe thanks

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Looks like you were denied solely because you gained weight. It says you don't meet both criteria. I'm assuming you meet the BMI criteria, but because you gained weight, you don't meet the 2nd criteria.

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[aslcertified 86]

Oh wow !!! Dang it , I guess I will have to start over

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[aslcertified 86]

But start weight was 240 and end weight 239. So I lost a little.

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[dede0314 356]

From the denial letter it looks like there are two reasons you were denied

[ZollDoll 21]

I just got off the phone with my insurance, apparently they are not covering the surgeon appointments (SERIOUSLY) uggh anyway I asked how long it takes once we send in the paperwork for approval, they told be 20 business days.

20 business days - that is another month. All my pre-op stuff (NUT, Cardio and Pulmonary) are finished by September 23rd.

I hope I am able to get this surgery done this year. but a month just for approvals is already putting me at November.

[SouthernSpinoza 2]

From the denial letter it looks like there are two reasons you were denied

You have to meet both requirements, but she wouldn't meet both if she didn't meet one.

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