Denied!

[GettingDHealthy 6]

Hey all, I was just wondering if there was anyone here who has dealt with Aetna and been approved on an appeal? I just found out this week that Aetna denied my surgery because the plan my company has doesn’t cover bariatric surgery. I am appealing but was wondering if anyone has ever had success with an appeal through Aetna?

[gabybab 696]

I had Aetna and they had an ironclad exclusion, so I never applied to be approved. I know firsthand how frustrating it is. I hope you win the appeal!

[GradyCat 3,696]

That doesn't sound like you were denied for a reason that is able to be appealed. They didn't deny you based on any criteria of yours, your company just chose not to include bariataric surgery on its policy. I think it's pretty iron-clad.

[Frustr8 7,886]

Not a right thing but many company plans try to meet their budgets by excluding things, I have heard there are states where this practice is now illegal, but can't tell you off the top of my head which ones. Do know there is a Non-Fat discrimination,law in Michigan but doubt this pertains. Way back,when I was BAKING my son, the Tomkitten , Conneticut General tried to deny us maternity coverage, their excuse? I shall Quote: "Pregnancy is an avoidable disease, we do not feel we should extend You Coverage for this Condition" Not only did I win the Appeal, the paper is framex and hanging on my wall. Every once in a while, I point it out to TK, "look what Mama went through to get you here healthy and sound!"Is he grateful? Well he does smile a lot. Heard him tell a friend Mama and Daddy has my sister because my paternal grandparents wanted a 👧 girl, then they had my brother because my maternal grandparents wanted a 👦 boy, but ME, they had me out of love and that I was just what my family needed!" Thought that sounded cool and I guess it was The Truth!😝

[SusieQ2019 567]

I agree with Grady, if it is not part of your insurance plan I don't see how the appeal will be successful. I have Aetna and the first thing I did was to check with them to make sure my surgery will be covered and my surgeon was in my network. You can also check with the company you work for to see they can add this type of service to the plan they offer.

Good luck to you.

[GettingDHealthy 6]

I called and spoke with an Aetna representative when I started the process and she told me that I needed to have the surgeon submit all of my paperwork to find out if the surgery would be approved or not. She didn’t say anything about an exclusion. I wouldn’t have gone forward with everything had I known.

[SusieQ2019 567]

Interesting, I am surprised that the rep did not explained to you whether or not your plan included bariatric surgery. I hope you find a way to have the surgery done, especially with the preparations you have done so far. I would be angry.

Hoping for a happy ending for you.

[bikerchick519 202]

my previous employer had an exclusionary policy for bariatric surgery and there was no fighting it.

[RNY4ME2020 39]

If it is excluded there is no way to get it over turned. I would look at changing insurance or paying cash.