Denied....

[NewtummyforME 0]

After waiting patiently on what I thought was going to be an approval, I got denied.

I am insured thru Aetna Student Health and apparently I have an exclusion on my plan for bariatrics. Had I known this before, I wouldn't have put myself through all the doc appt.., psych eval, nutritionist appt., and all the other hoops I had to jump thru.

I am sickened by the answer of my insurance company. On the website with my benefit package on it, the exclusions do no specify that I would not be covered. My insurance agent at my school (Northern Arizona University) had told me a few times that this WAS NOT an exclusion.

I am once again at a stand still. What do I do? Is it worth it for me to appeal this? I cannot afford self-pay and unless I find someone who would like to pay for this life changing surgery for me, I feel as though I am outta options...

~Julie

[DownInSocal 12]

After waiting patiently on what I thought was going to be an approval, I got denied.

I am insured thru Aetna Student Health and apparently I have an exclusion on my plan for bariatrics. Had I known this before, I wouldn't have put myself through all the doc appt.., psych eval, nutritionist appt., and all the other hoops I had to jump thru.

I am sickened by the answer of my insurance company. On the website with my benefit package on it, the exclusions do no specify that I would not be covered. My insurance agent at my school (Northern Arizona University) had told me a few times that this WAS NOT an exclusion.

I am once again at a stand still. What do I do? Is it worth it for me to appeal this? I cannot afford self-pay and unless I find someone who would like to pay for this life changing surgery for me, I feel as though I am outta options...

~Julie

My first stop would be the insurance agent. Remind them you were told this was not an exclusion and see what they say. After this I would appeal. I know there are some great threads about what people have put in their appeals packet.

Don't cry. I have a strict policy that no one cries alone. Good Luck.

[ParrotheadCathy 0]

Call your insurance company. Ask them specifically if there is a written exclusion for WLS in your policy. I've heard of more than one person who's doctor's office got it wrong. Unfortunately, if there is an written exclusion, you can't even appeal around that. So make the call, get the information. Good luck!!!

PS, is self-pay an option?

[Angie65 7]

The same thing happened to me. There is no appeals with a written exclusion. I was told several time there was no written exclusion but, there is. Now, all I get is I'm so sorry. I refinanced my house to pay for the lap band. I no long have cable tv,a daily newspaper, a home phone, or I no long go anywhere that involves money. I am worth it!!!

Good luck:thumbs_up:

[sweetheart181 10]

I have aetna and they denied me at first too. My doctor talked to them and then they said that if I did a 6 month diet I could apeal their decision. I did the diet and they approved me. don't give up with aetna, call again and see what they can do.

[kgloverii 0]

If there is a WLS EXCLUSION, then there is no way to appeal around it. If it was a denial based on other factors, then you may have hope. Aetna policies are different for each company, and just because someone was denied and eventually was approved does not mean that it is something that can/can't happen in your case. I truly feel for you, and if WLS is indeed an exclusion, I am sorry. I too had to self-pay. Of all of the different insurance policies that DH and I have had through different employers, we've never had a policy that has covered bariatric procedures....