Denied

[Kimmy 0]

I just found out I was denied by Aetna. I am so upset. Now I have to go through an appeal process. I just want to crawl in a hole. I haven't rec'd the official letter yet, but just got off the phone with the insurance company. They said my doctor's office did not provide the surgical prep regimen. That they need that and the fastest way to get appealed is the surgeon to call in a do a "peer to peer" with the insurance company. I called the doctor's office and they don't know what the surgical prep regimen is and the doctor does not do "peer to peer". After several more calls - I have to wait for the official letter and send in a letter of appeal. I am sick to my stomach. I am very upset that my surgeon can not make a phone call on my behalf. Is this going to happen for me???? I can't quit crying.....

[texasweb 0]

Ask your insurance company to send you documentation on what is needed for the surgery to be covered. I had mine do that and it was black and white on what was needed. This will probably cut down on the number of calls and will help in sending in the appeal. Just call them up and request the information now. That way you can get your appeal set up.

[123crod 170]

I just found out I was denied by Aetna. I am so upset. Now I have to go through an appeal process. I just want to crawl in a hole. I haven't rec'd the official letter yet, but just got off the phone with the insurance company. They said my doctor's office did not provide the surgical prep regimen. That they need that and the fastest way to get appealed is the surgeon to call in a do a "peer to peer" with the insurance company. I called the doctor's office and they don't know what the surgical prep regimen is and the doctor does not do "peer to peer". After several more calls - I have to wait for the official letter and send in a letter of appeal. I am sick to my stomach. I am very upset that my surgeon can not make a phone call on my behalf. Is this going to happen for me???? I can't quit crying.....

Sorry you feel so bad. I will pray that the the appeals process will work and you will be approved. Let us know what happens. I am praying.

[Kimmy 0]

Tex, thank you I will call right now. And 123, I thank you for the prayers. They are very much appreciated. I feel this is my last hope and I feel it slipping away........

[123crod 170]

I feel like it will all fall into place. Just don't panic. Hope and believe is all we can do just keep thinking positive.

[RestlessMonkey 7]

Maybe too you should think about getting a different surgeon? If yours won't make a phone call for you, well...how will he be there in other emergencies? I seriously would switch if it were me. There's more to the band than just getting it placed...aftercare is VITAL.

Maybe this is karma or something trying to help you switch NOW!

[123crod 170]

Maybe too you should think about getting a different surgeon? If yours won't make a phone call for you, well...how will he be there in other emergencies? I seriously would switch if it were me. There's more to the band than just getting it placed...aftercare is VITAL.

Maybe this is karma or something trying to help you switch NOW!

I agree with Restlessmonkey. You need a Dr. and staff that will be there for you at all times:rolleyes:

[lamber2299 0]

Get a new doctor! I originally went to one doctor and after several months of back and forth, was denied. I had to constantly call the insurance company to find out the status and they were always waiting for something from the doctor. After I was offically denied for lack of a six month nutrition counseling, I spent several more months trying to find out from the doctor what I needed to do. The office would never call me back. I finally switched to another doctor in March, started the nutrition classes in April, and recieved a call in July that my insurance had switched to a three-month nutrition program, and am scheduled for surgery on the 18th. There are a lot of good doctors out there, but there, but I think having a good office staff is just as important.

[48Cyns 0]

I agree with everyone, find a surgeon AND back-office that cares and knows what they're doing! I have Aetna also and followed the 90-day pre-surgical regimen instead of a 6-month weight plan, first visit was in May and I have a surgery date of Aug 24th.

Don't give up, YOU CAN DO THIS!!!

[Mia26 0]

I agree, switch to another doctor. Surgeon's office should know the in's and out's of insurance companies and should be willing to go to bat for their patients! Is there a particular reason you choose this surgeon?

[Dana36 0]

Yep! Switch to another Surgeon. I'm just now finishing up my requirements (6 month diet, nutrition classes, etc..) and all along the way, the surgeon's office has called and checked up on me, directed me, and assisted me with any questions that I have. I want an office/surgeon that will be there when I need them to be there.

[Kimmy 0]

I thought this same thing all night last night! Thanks all for agreeing with that little voice in my head.

[BooCakes 0]

I agree with the other posters. The fact they don't know what the 3 month surgical prep program is, is kind of scary. It's a pretty common requirment, not only should they know, they should be telling and helping you!!!!

[Kimmy 0]

Well, after many discussions with the office staff - the girl that is handling this is fairly new. So I'm going to give them a break. The fact the doc won't do a peer to peer still upsets but, one of the girl friends used this doctor and I really feel comfortable with him. So for now - I'm not going to change doctors. I did send in my part of the appeal yesterday and the doctor's office said they sent theirs in as well. SO - we'll see what happens! The doctor I'm going to is Dr. Carter in Arlington, Texas. Pray for me!

[BooCakes 0]

I SOOOOO hope it works out for you!!!