Aetna Insurance denied & Appeal

[sweetsleeveday 11]

Does anyone has Aetna or other insurance with this problem.....My daughter was denied due to weight gain only 4 pounds and she has sleep apnea..her doctor stated he is going to appeal it.....so far she lost 8 pounds. Do anyone know how long is the process??? And did anyone go through this and won?

[Amburmist 55]

Does anyone has Aetna or other insurance with this problem.....My daughter was denied due to weight gain only 4 pounds and she has sleep apnea..her doctor stated he is going to appeal it.....so far she lost 8 pounds. Do anyone know how long is the process??? And did anyone go through this and won?

Are u certain the weight gain was the reason for the denial? Did they specifically tell her that? If they didn't give a specific reason, I would call immediately to understand why they denied. There can be so many hoops to jump thru, it may not be the weight gain. Was she doing the doctor supervised diet requirement?

Another thing, does ur daughter have a BMI over 40? I thought with a BMI over 40, it's usually the comorbidities (like apnea, diabetes, etc) that would allow an approval, not so much a weight gain. Hell, that's the whole reason we're trying to get these surgeries, for goodness sakes!

I know u said her surgeon is going to submit an appeal but I would certainly also be on the phone with Aetna to understand exactly why I was denied and what criteria I need to do to get approved. And how often can she submit to be approved for this surgery, if they end up denying the appeal? This can't be the end of it forever. Push on. Make them tell u how to get this approval!

I'm sorry she has to go thru this and I wish u guys all the luck. I hope Aetna relents and gives the damn approval!!

[sweetsleeveday 11]

Are u certain the weight gain was the reason for the denial? Did they specifically tell her that? If they didn't give a specific reason, I would call immediately to understand why they denied. There can be so many hoops to jump thru, it may not be the weight gain. Was she doing the doctor supervised diet requirement?

Another thing, does ur daughter have a BMI over 40? I thought with a BMI over 40, it's usually the comorbidities (like apnea, diabetes, etc) that would allow an approval, not so much a weight gain. Hell, that's the whole reason we're trying to get these surgeries, for goodness sakes!

I know u said her surgeon is going to submit an appeal but I would certainly also be on the phone with Aetna to understand exactly why I was denied and what criteria I need to do to get approved. And how often can she submit to be approved for this surgery, if they end up denying the appeal? This can't be the end of it forever. Push on. Make them tell u how to get this approval!

I'm sorry she has to go thru this and I wish u guys all the luck. I hope Aetna relents and gives the damn approval!!

@Amburmist....me and my daughter did the program together we have almost the same BMI about 38 and sleep apnea....she is under my insurance I was approved and she wasn’t they claim that she did not go to some class which is a lie cause we did it together and that she gain 4 pounds and did not lose no weight...I’m really upset and angry...but I told her if the doctor appeal fail...I’m going to do my surgery...and come November I could change insurance due to my job and will get BCBS and let her submit her paperwork and see if she get approval with them..I’m praying and hoping that doctor appeal get approval and that I don’t have to change insurance...but I don’t know how long the appeal takes..

I feel like Aetna is not telling the truth about something it just doesn’t add up.

[sweetsleeveday 11]

[mention=326905]Amburmist[/mention]....me and my daughter did the program together we have almost the same BMI about 38 and sleep apnea....she is under my insurance I was approved and she wasn’t they claim that she did not go to some class which is a lie cause we did it together and that she gain 4 pounds and did not lose no weight...I’m really upset and angry...but I told her if the doctor appeal fail...I’m going to do my surgery...and come November I could change insurance due to my job and will get BCBS and let her submit her paperwork and see if she get approval with them..I’m praying and hoping that doctor appeal get approval and that I don’t have to change insurance...but I don’t know how long the appeal takes..

I feel like Aetna is not telling the truth about something it just doesn’t add up. Oh the doctor is not appealing....he is doing a disputed. I hope she gets approval..I don’t how long it takes for a disputed..

[mzsantiago88 145]

If the class had a sign in log you can submit that as proof for your appeal hope everything works out for you

[Amburmist 55]

[mention=326905]Amburmist[/mention]....me and my daughter did the program together we have almost the same BMI about 38 and sleep apnea....she is under my insurance I was approved and she wasn’t they claim that she did not go to some class which is a lie cause we did it together and that she gain 4 pounds and did not lose no weight...I’m really upset and angry...but I told her if the doctor appeal fail...I’m going to do my surgery...and come November I could change insurance due to my job and will get BCBS and let her submit her paperwork and see if she get approval with them..I’m praying and hoping that doctor appeal get approval and that I don’t have to change insurance...but I don’t know how long the appeal takes..

I feel like Aetna is not telling the truth about something it just doesn’t add up.

Have u or ur daughter called Aetna customer service to speak with someone personally to find out what the reason for denial was? Or are u getting the info second hand from the doc? I would suggest calling Aetna if u havent already. I wish u and ur daughter luck whichever route u need to take.

[jcb123 115]

5 hours ago, sweetsleeveday said:

5 hours ago, sweetsleeveday said:

[mention=326905]Amburmist[/mention]....me and my daughter did the program together we have almost the same BMI about 38 and sleep apnea....she is under my insurance I was approved and she wasn’t they claim that she did not go to some class which is a lie cause we did it together and that she gain 4 pounds and did not lose no weight...I’m really upset and angry...but I told her if the doctor appeal fail...I’m going to do my surgery...and come November I could change insurance due to my job and will get BCBS and let her submit her paperwork and see if she get approval with them..I’m praying and hoping that doctor appeal get approval and that I don’t have to change insurance...but I don’t know how long the appeal takes..

I feel like Aetna is not telling the truth about something it just doesn’t add up. Oh the doctor is not appealing....he is doing a disputed. I hope she gets approval..I don’t how long it takes for a disputed..

Hmmm, this doesn't sound right. I also have Aetna and I gained 10lbs during my 6 months "dieting". I was approved two weeks ago. I would call Aetna and try to get to the bottom of this. Doesn't make much sense to me.

[CrissCriss 97]

I have aetna according to my coordinator when ever they appeal it's always approved. I don't know the turn around time.

[sweetsleeveday 11]

I have aetna according to my coordinator when ever they appeal it's always approved. I don't know the turn around time.

Thanks...the doctor is going to dispute it and if that doesn’t work...I’m going to appeal it.

[sweetsleeveday 11]

Thanks...the doctor is going to dispute it and if that doesn’t work...I’m going to appeal it.

Yes...Thank God....my daughter is approved...also thank god to the doctor..I’m so happy [emoji847][emoji847][emoji847] now Mom and daughter having surgery together tomorrow...yes Amen [emoji120][emoji847]