Hoping to be banded, insurance coverage denied

[SusieW128 0]

Hello from Jacksonville, FL!

The last few months I have been going through the process for lap-band surgery. Yesterday, I received a "denial of coverage" letter from Aetna. I called my doctor's office here in Jacksonville, FL and was told my doctor would do a "peer to peer review." Does anyone know what this means? I am new to this whole process. Has anyone gone through this? Thanks for your response.:cool2:

[Tamihott 0]

I would say it is great news that your dr's office is willing to help you! In most cases the dr or someone from the srugeons office will speak with and plead your case to a medical person from Aetna. I wish you the best of luck! Tamara

[Jeanmarie 0]

Hello! I also have Aetna and the process took me a year because they also kept denying me. I started the process 8/7/07 and my initial surgery date was 2/14/08 but it took until the 3rd level of appeals before i was approved and finally was banded on 7/29/08. Almost a year later! What happened for me was my office sent in a second appeal with all of the records. Then Aetna set up a telephone conference (with reps and drs and nurses from Aetna) with me where they asked me lots of questions. After that was denied it was sent (by my Drs office) for a third level of appeals where they had outside physicians review my chart and make a decision and THEY finally approved me. Just be patient. My drs office told me they usually do ultimately approve you. Hope this helps. Good luck!!!

[SusieW128 0]

I will hang in there and see what happens. My BMI is 56. I thought they wouldn't deny the surgery. I have done most everything my dr has asked me to do except for the 3 month supervised diet and everything that goes along with that. Thanks again, Susie:smile2:

[SparkyJ 0]

I can't remember how many times I was denied in the last 6 months, then finally, they sent it to their review board and it was approved! I now have to complete an 8 week weight management, with success, and I see the surgeon this month. Hang in there-Last November, I approached this as well-I will throw my name in the hat and see what happens...played it out as the paperwork started to roll in...now all of a sudden, I am getting very close to the end of this process-begining of another!

[*susan* 1,709]

Hi Susie, I just noticed that you are from Jacksonville, as am I. So, I just wanted to stop in and say "hi neighbor"!