6 months hell and Aetna said NO-devastated

[aubrie 6]

I haven't posted since 9-11. I've been punched in the gut. I worked HARD for 6 months to do everything that Aetna required of me to have the surgery, and they still denied me. I'm devastated. I can't remember the last time I cried that hard.:think My husband was frantic, and did everything to console me. Now I'm just angry and bitter. :mad:Being fat has it's own particular set of psychological crap. But what Aetna has done has REALLY messed with my head. It's cruel and sadistic. what they are doing should be illegal. If I had the money, I would go after them legally, because I KNOW I'm not the only person they have put through this. I basically gave up. I started eating again, and regained all my presurgery weight and then some. I got a health club membership about the same time I was denied, in hopes of having it help. I haven't even set foot in it. I can't. It's to painful. My husband has finally talked me into fighting and going through the appeal process. I'm going through the motions, but my heart isn't in it anymore. I can't face any more disappointment. Have any of you been through this emotional roller coaster? How did you get out of the funk and depression? :faint:Was it worth the effort, or did you have to end up paying yourself? I have two kids in college. That is NOT an option for at least three more years. (or more... I'd have to actually be able to save it) What do I do????:cry

[edieparks 2]

I figured I spend at least $7 dollars a day on my addiction and I think that was VERY LOW estimate. That gave me $7 times 30 days in a month for $210 to pay on a loan for self pay.

Could you and your husband maybe do the math on how much you spend on keeping your weight up? I know it isn't a nice subject to think about but that weight doesn't stay on the body without feeding it. Feeding it cost money.

I also never bought any fancy Protein anything. I just used Carnation Instant Breakfast meals, even the Kroger brand of this for my Protein Drinks. I notice Walmart has a Great Value version too.

Please pm me if I can help you.

edie

[whosyadaddy 0]

aubrie.

I got denied to after 6 months of jumping throgh hoops. this is NORMAL!!!! they do this the majority of the time. ITs like they try it just to see if it will make you give up.

Talk to them and APPEAL APPEAL APPEAL. I appealed and 3 weeks later got approved!. DOnt give up on them, thats what they want you to do!!!! ask for denial reason. The one they gave me was not even valid i found out.

DONT let them get away with it!!!!!

[VegasGrace 1]

Sorry you went through this. You could appeal...

or just decide that you are so worth it. Get your kids to max out the student loans for a semester....take that and get the surgery done...there are tons of reputable places that you can have it done for 7-10k, and pay those student loans off.

$7,000 is worth it for a lifetime of control and not feeling dependent upon an insurance company.

[TerriDoodle 6]

I've seen members post here who were denied 3 or 4 times before they were approved!! APPEAL, APPEAL, APPEAL...Your doctor probably knows the routine and can be very helpful.

Find out what you need to do and then do it! Be persistent!! You can do it!! I've seen it done many times!

[faithmd 14]

Obesity Law and Advocacy Center

For a reasonable fee this firm will help you with an appeal, DO IT!

[faithmd 14]

I do not work for, have not used and know nothing personally about Walter and Kelly, other than reading mostly positive comments here and on other boards about them and their practice.

[bmysuccess 0]

Appeal, Appeal, and call them everyday. Don't give up on this, have every Dr. you've got get involved.

[whosyadaddy 0]

Yes Walter got me APPROVED!!! He kicks butt!!!!!!!!!!!

[Margie122 845]

Appeal! They are probably hoping you'll just go away (because so many people do)...file the appeal, you are worth it.

Call them and ask to speak to the person in the unit that made the decision and then ask WHY you were denied, and then ask for them to send it to you in WRITING.

I am also sitting waiting for my insurance company to approve/deny me. I know I meet the criteria because I called and asked them. Now granted, I still expect they could deny me which is why I've already downloaded the appeal forms. I also checked out that Obesitylaw.com place and I may call them if my insurance company doesn't get around to approving me. My doctor sent in my surgery request on 10/5 and the clinical notes etc. on 10/12 and they still haven't made a decision....my surgery is scheduled for 10/31. I CALL THE INSURANCE COMPANY EVERY OTHER DAY TO SEE WHAT THE STATUS IS. THE SQUEAKY WHEEL REALLY DOES GET THE GREASE....AT LEAST GIVE THEM A HARD TIME ABOUT IT. Do NOT give up.

:clap2::clap2::clap2::clap2::clap2: Make as much noise as you can with the company, and if you haven't already - WRITE DOWN THE NAME/DATE/TIME every time you speak to someone and what they tell you.

[WASaBubbleButt 41]

What was the reason for denial?

[Chrisann 0]

I thought the surgeon's office goes after the Appeal and pre-certifications for you. Maybe I am wrong.

[KYteacher 0]

I was also denied and it took a year for me to finally get approved. It is worth it...keep fighting!

[newimage 2]

Don't give up! I will be pulling for you!

[aubrie 6]

The reason for the denial? One was that the doctor's 6-month diet notes weren't good enough.... lovely.... they also added some undefinable psychobabble. Not really sure what they were getting at... I've gone to a dietician, my regular MD who did the 6-month diet, my rhumetologist who says it will improve my arthritic knees and hips, my heart doctor who says it will improve my overall health, stress on my defective aortic valve and reduce my blood pressure, went to my OB/GYN who says my stress incontinence will improve with weight off my abdomen, I had a psych evaluation which I passed with flying colors, I've attended numerous support group sessions, and have had a sleep study done. I don't have sleep apnea, but do have disruptive sleep. what's next? giving up my first born child? there is NOTHING left to do. That much documentation is not good enough? I'm very tempted to try the obesitylaw.com route. I've done everything they have asked.