Aetna Insureance Denied......

[TulipsRosie 0]

Hello Everyone,

My name is Maria and I just found out that Aetna has denied my request. :thumbup:

I am 5' 6" and currently weight 270lbs. My BMI is about 40. I fortunately (or unfortunately) do not have any medical concerns. I have a family history of Diabetes, High Blood Pressure and Cholesterol, but Aetna seems to think that this is not enough. They are looking for a 2 year weight history. I tried to get my records from a free clinic that I used to go to before I got insurance, but they purge their records after 2 years. It has been about 2 years since I have gone there. I have one year of history that I have been able to obtain but that may not be enough.

Wish all you guys and gals the best.

[El Diablo 1]

This is not what you want to hear but.....it took me a year to get to where I'm at now. Don't give up, just start getting it documented from now or maybe even better try for an appeal.

Good Luck

[KyBandChick 3]

Do you have anything from 3 or 4 years ago that is the same weight range? I didn't have 2 years either b/c I didn't go to the doctor much but I did have information from 3-4 years ago and Aetna took that

[Miriam 0]

I bought the "Weight Loss Surgery for Dummies" book and there is a really helpful sample of a letter you can write to Aetna to petition their decision. You can also include testimonies from past doctors, even if they no longer have some of the records. You might even want to consider using a few pictures of you from a few years back as documentation, every little bit helps! Good luck!

[lacasst 1]

It took me almost 2 years,3 doctor's,6 months weigh-in's,completeing healthy roads(phone counseling program)my ins company changed twice,tons of phone calls,begging,pleading and finally writing a heavy duty tear jerking.........please help me save my life appeal letter!! So dont give up!! persistence will pay off,you know what they say about that "squeaky wheel"!!:thumbup:Plus if it's meant to be it WILL happen.....dont give up on your dream!!

[TulipsRosie 0]

Thank you all for your words of encouragement. I will hang in there and hope for the best. But as you guys already know, we want things to happen instantly since we have been dealing with this issue most of our lives.

I will try some of your suggestions.

Thanks again

[Goalwatcher 0]

I'm in the same boat as you...no comorbidities.

I found out at the end of last week that they denied me, too. I was missing a recorded weight from 2007. My surgeon's office had my PCP write on a prescription note that they had seen me twice in 2007, didn't weigh me, but I hadn't lost weight during that time. My weights from 2005, 2006 and 2008 were all submitted. Plus I gained a pound even after seeing the nutritionist. The morning of the day I received my letter Aetna annouced a substantial fiscal loss in their 4th quarter last year, so I took that as an omen that I would be denied, and I was.

My surgeon is doing a physician to physician review sometime soon. We'll see what happens.

Best of luck, and I know exactly how you're feeling.

[TulipsRosie 0]

Wow Goalwatcher,

Not something I wanted to hear about Aetnas loss :tt2:. But I think that we should keep at it and think positive. :tt2:

They say that Hope is the last to die.

[Goalwatcher 0]

Update: My surgeon did the MD to MD and I was still denied. They've referred my case to Obesity Law, and I'll find out soon whether or not they'll take it on.

[TulipsRosie 0]

Hello All,

I have gone the my 6th nutritionist visit which completes the 6 month diet plan. I have also found about a year and a half of weight history. I am also going to include a letter written by me and some photos of me throughtout the past 2 years.

Keeping my fingers crossed.

-Maria