Letter From Insurance ???

[BooCakes 0]

I got a letter from the Insurance (Aetna POS II) saying that they need more info to make a final decision. Everything they want is pretty much EVERYTHING THEY NEEDED. The 2 year weight history, Dr's notes, nutrition notes etc. Everything that I did with my Dr's. office. I hate to complain to my office cause they have been great in handling everything and seem to be pros and have it all under control, but how could I be submitted without them sending all that. I'm just frustrated cause it's been almost 2 weeks now and I'm getting anxious.

I was just wondering if anyone else had the same thing happen?

Boo

[Mamacita14 6]

Hey BooCakes

Have you tried calling the insurance company to see what the heck they are talking about? I would call them first and then call the doctor's office. They will be glad to help you and you are correct they should know exactly what to send. Let me know how it goes. I have the same insurance and will submit my paperwork next week.

[sharie3 0]

I would call them. I got a letter from my insurance (bbcbsil) that I was denied because there was no record of the 3 month non surgical weight loss program. I talk to the DR. office they said they sent 81 pages. So I called insurance co. They said they had the paper but for some reason it was not sent to the approval committee. They sent them an I was approved an hour later! Good luck!

Sharie

[hardygostlin 0]

I was originally denied for my surgery. I was instantly mad at the surgeons office since the denial letter stated they didn't receive all the information needed. I called the insurance company and they told me I could appeal it, but it could take up to another 4 weeks (it really only took 2). I compiled all the information myself (notes from PCP, lab work, ect.) wrote a letter, and submitted the information to the insurance company myself. That way I knew they'd received everything. (I work in HR/Benefit for a living so it was nothing new to me.) My surgery date is September 17. If there is anything I can do to help, let me know. We need to get you past this little bump in the road to "Loser"ville!

[BooCakes 0]

Thanks everyone! I have called and apparently they did get everything and it's a form letter informing me of what they do need to give approval, although it reads that they still need it. Anyway, the office did send over everything and they do have it. I was submitted two weeks ago and they told me I was just submitted and put in the system yesterday. I am just so annoyed. I knew it was too good to be true that I'd be a "Got approved by Aetna in 2 days" post. LOL Oh well, as long as I get approved, I don't care what mess they put me through. LOL

I'll be sure to post when I do hear something. I might call again tomorrow.

[Julia_N 2]

I have Aetna and there was an initial screw-up when they didn't think they had all the paperwork. My doctor's office straightened them out and the approval process began. I think it took about 2 weeks to get approval.

Good luck to you!

[yzplnxg 0]

I sure did. My PCP was supposed to have sent a letter outlining my co-morbiities. He had sent one letter saying I had to have thyroid surgery. I thought they had gotten the second letter.. which would have provided the "five year diagnosis of morbid obesity" which UHC requires.. I told the ins clerk the requirements.. It wasn't until the appeal that I asked the surgeon's office to make a copy of everything they sent the insurance company that I realized what was missing. I'm still in the appeal and hope I have given the insurance everything but I may still get something saying they need something else.. I should know something by the 17th. I wish UHC would tell me what else they need BEFORE they deny me so I would have the opportunity to provide the info BEFORE the denial.

[hardygostlin 0]

I sure did. My PCP was supposed to have sent a letter outlining my co-morbiities. He had sent one letter saying I had to have thyroid surgery. I thought they had gotten the second letter.. which would have provided the "five year diagnosis of morbid obesity" which UHC requires.. I told the ins clerk the requirements.. It wasn't until the appeal that I asked the surgeon's office to make a copy of everything they sent the insurance company that I realized what was missing. I'm still in the appeal and hope I have given the insurance everything but I may still get something saying they need something else.. I should know something by the 17th. I wish UHC would tell me what else they need BEFORE they deny me so I would have the opportunity to provide the info BEFORE the denial.

When I was denied the first time, the insurance company sent me a letter detailing why I was denied. I provided the information to them with my appeal letter and 2 weeks later had my approval. Did they send you a letter after the denial? If not I would request one.

[yzplnxg 0]

They have had the appeal for ten days. I should hear something back on the 17th. I'm holding my breath!! The denial said they needed "a diagnosis of morbid obesity of over five years" I sent in a letter from my PCP I was a page type written from my PCP outlining all the things he was treating me for and the times I had been treated for weight control.. and a sentence saying I had been morbid obese for over five years.. I'm hoping that will surfice. I have no way of knowing what they are reallying looking for...

Oh well... I am so hoping the wait is almost over!!

[BooCakes 0]

Just wanted to update that I have received approval. I guess everything was fine it just took a little longer then usual. Which is fine by me, as long as I got approved. :thumbup:

Good luck to everyone else. It can be so nerve wracking waiting!