Denied and need your help

[lisac82 0]

Hi Everyone,

I just found out that I am denied!!! My paper work was submitted last thursday 4/30 and I called my insurance company AETNA (I have EPO) and the rep told me I was denied because I was missing paper work, what???? My case worker sent my psych evaluation, dietition visits, my weight history, a personal letter from myself, and a letter of medical necessity. I asked what paper work I was missing and he was unable to tell me, he said I would recieve a letter. I don't know what to do it seems like my dreams have been crushed I dont have any money to self pay and I am going to appeal but I dont even know how that process works. Has anyone been denied for the same reason "missing paper work" ? Has anyone appealed? If so, what is the process? Please help I am not going to give up, I need this!!!!!!!!!

[RestlessMonkey 7]

IMHO you should wait to panic until you have the letter and see WHAT is missing. Many insurance companies stall this way; and it is possible something got lost (the stuff IS processed by humans and we do occasionally lose things etc) The letter will let you know how to proceed.

[LJB 0]

Yes - I agree with Restlessmonkey - It will be OK just wait and find out whats missing. than resubmit it again. I'm sure it will all work out.

[TxRNLori 0]

I am a Bariatric Coordinator at a Center of Excellence in Texarkana, Texas. People are denied all the time and appeals happen every day. Many of these are successful. I can't believe someone submitted your paperwork incomplete. You are allowed an appeal with most insurance companies but be careful and make sure all the paperwork they want is complete since you can exhaust the process by submitting partial requirements. Go to the Aetna web site and see what their criteria is and make sure you have supporting documents for what they require. Aetna is a stickler.....but they do pay if you do not have an exclusion.

[keithf 2]

I can't believe someone submitted your paperwork incomplete.

In my case, my PCP had submitted everything he had -- what was missing was my fault. While he had anecdotal evidence of my apnea, he didn't have record of the actual study that had been performed years ago and in a different state.

Some delayed response on my part in getting him copies of the records, he was able to amend the file.

Would it be something like that?

[pennreporter 12]

Many insurance companies will automatically deny to keep from having to pay. Get your letter, make sure you have everything complete, file your appeal. Then if it's denied again, there are attorneys that that's all they do is handle medical appeals. My daughter was denied but she met BMI requirement but not the comorbidity (blood pressure, etc) requirement. So it would have been hard for her to fight it. She just ended up going from NY to Houston to have it done. Luckily my insurance company has approved but I was ready to fight if they denied. Good luck. Don't give up.

Trisha

[silvers320 12]

I appealed Aenta. The denial letter was simply said I did not meet the requirements. I got the appeal requirements and appealed Aenta and filled an appeal with the state insurance department. It turned out that they were missing paperwork, which I had sent in. So appeal. Check the facts and date for an appeal to your state insurance department. I remember at least in NY, there being an reason to appeal both the Aetna and the state insurance department at the same time. I think it had to do with the number of days for Aenta's vs the time you had to file with the state.

[windyacres_2000 1]

I have Humana, and am having a terrible time finding the information I need online. Any advice?