AETNA denial

[lisac82 0]

Hi Everyone I just recieved my denial letter and the reason why I was denied was and I quote, "The information received does not indicate the presence of morbid obesity that has pesisted for at least 2 yrs, whiich can be defined as either (1) body mass index (BMI) exceeding 40 or (2) BMI greater than 35 with any of the following severe medical conditions....well my BMI this year was over forty however last year its highest was 37.20 and for 06 is 38.2. I do not have any other medical conditions besides my weight.

So the reason that I was denied was that I did not meet the weigh requirement for 07. I lost and gained weight this is the story of my life. So now I dont know what to do or what can I do? I do not have money to self pay I was wondering if anyone was ever in this situation and had their decision overturned or can any one give me advice on what I can do? Thank You

[Jodi73 11]

I would make absolutly positive you do not have any co- morbidities. Have a sleep study, make sure your BP isn't slightly high, or see if it has been in the past two years, check your cholesterol levels. Have your PCP check any and everything, maybe you are less healthy than you think! Congrats, right?! Its terrible to think we would welcome one of those conditoins! If you do have any of those conditions, get your PCP to document, and add a letter of necessity, then resubmit. Also, Aetna is a stickler for documentation, be sure your PCP is VERY thourough in the notes!

[lindas0809 0]

Lisa - I AM SO SORRY!! I agree with the previous poster that you should pursue all comorbidity possibilities. Get a sleep apnea test, check for borderline high BP or have a blood glucose tolerance test. If none of those pan out go through your medical records to the very first date in the past two years that you were at a 40 BMI and start counting your two years then. It may mean you have to resubmit later in the year(and I know waiting seems impossible), but at least you know you would be covered.

I hope you can appeal with something - let us know how it goes.

[stellaabbey 0]

My denial letter from Aetna, read the same as LISAC82. I DO have hypertension, but my weight was not high enough for the last 2 years.

I thought about going for a sleep study, but that could take time. I was supposed to have surgery yesterday, but that was cancelled on Friday.

My DR office is not much help either. I have left so many messages for them to call me, but they are not returning my phone calls. Very frustrating.

[adagray 1]

If you have weights that are higher previous to 2 years, I'd submit those w/an explanation that the lower weight within the 2 years was temporary from dieting, but you could not keep it off. At least this is what my surgeon's office is going to do for me when they submit my paperwork. I can show weights high enough for the past 5 years, but in 2007 I had some success on WW and have a lower BMI. I know they will reject my first application. That's pretty much guaranteed. But, I think we may be able to get it on appeal.

[Huskergirl 0]

I'm really sorry to hear that, as I am also going through Aetna. Could you tell me what exercise and dietician program they approved for you? I'm having quite a time getting them to approve what they call an "exercise therapist". Keep fighting them! I'm sorry your Dr. isn't much help.