Aetna Denied - Everybody's blaming each other

[Chasidy 0]

So Aetna denied my surgery originally saying "not medically neccessary". My policy benefit states that I must have a BMI of 40 or 35 with two co morbidities. I have a BMI of 42. What could be more neccessary?!?! I'm not very patient so I've called the doctor's office several times over the past couple of days. Well today - the answer is this - Aetna says I didn't complete my three month multi disciplinary. I did. So I called Aetna and they say the doctor's office didn't submit the paperwork for all three months, and if they just submit that the denial should be over turned. However, the doctor's office has now said that my surgeon is going to call Aetna's medical director to get it over turned. Did anyone have this much trouble and if so is there ANYTHING I can do to help this process through? I've made appointments with my family doctor and with my ob gyn to get letters of recommendation from them. But that's going to take weeks.

[Linda D 0]

Hang in there with the insurance. It's good that you're right on top of it. With the primary care Dr and OB, my surgeons office has a letter that they fax to the other doctors, they sign and fax back. I didn't have to contact the Dr myself nor make an appt. I hope that helps. Hang in there!!! )

[catfish87 3,471]

So Aetna denied my surgery originally saying "not medically neccessary". My policy benefit states that I must have a BMI of 40 or 35 with two co morbidities. I have a BMI of 42. What could be more neccessary?!?! I'm not very patient so I've called the doctor's office several times over the past couple of days. Well today - the answer is this - Aetna says I didn't complete my three month multi disciplinary. I did. So I called Aetna and they say the doctor's office didn't submit the paperwork for all three months, and if they just submit that the denial should be over turned. However, the doctor's office has now said that my surgeon is going to call Aetna's medical director to get it over turned. Did anyone have this much trouble and if so is there ANYTHING I can do to help this process through? I've made appointments with my family doctor and with my ob gyn to get letters of recommendation from them. But that's going to take weeks.

I would certainly suggest to stay in contact with your pcp office and your lap band surgeons office. They both want you to succeed! Myself and my partner both have aetna and both got denial letters at first. Within about a week, the proper paperwork was submitted, mine was 6 months of supervised dieting, she had a bmi of 38 with many family histories of weight related problems. Ours were both approved within a week or so of original denial. I was banded on sept 28, hers is nov 12. Hang in there and keep on them! You'll be banded before you know it. I've been banded a month tomorrow, and including pre-op am down 50 lb.

[Erin Marie 0]

I also have Aetna and they did the exact same thing to me. They kept saying I didn't have this or that when they know they full well did. I had to appeal and still got turned down for more things that I had already completed. Eventually my Bariatric Center sent in their pro bono lawyer and I got a letter retracting the refusal about a month later.

Just hang in there. They can't deny you forever and it sounds like your Center is right on top of em'!

[ParrotheadCathy 0]

You wouldn't be the first person I've see on here (and another site I go to) to say that they were denied...only to discover their doctor's office didn't send all the pertinent paperwork.

STAY ON THEM. It's just not that difficult to get it right. Demand that they do.

[Chasidy 0]

Update..... when I called the doctor's office yesterday to see if he had made the call to Aetna's medical director, he hadn't. His wife was in labor....great for them, not so much for me. I just wish I could have more patience. I told the girls at the office what the insurance company had said about additional progress notes and asked if they would send them and they said sure! As of yet - they haven't. I feel like I could crawl out of my skin waiting on a response. I feel like I have put so much into this and the people I'm forced to depend on don't really care.

[BigMomma 0]

I know the feeling. I had my last nut appt on the 21st. I figured the center submitted my info that week. I received an email from the center that they did not submit until the 29th. WTH?? So now I have an additional week to find out the results. I'm going crazy!!!!

[terriamn 0]

I can also relate to the hassle. After waiting to hear back from the insurance company I called the doctors office and they hadn't submitted my papers. Dietican didn't check that my insurance didn't need follow up visits with her and unbeknown to me had scheduled another appointment. So I had to start the wait all over. Got the good news today, insurance said yes.:Yawn:

[BigMomma 0]

Congrats Terrianm!

[terriamn 0]

Thanks BigMama, excited, nervous and scared. My family isn't thrilled with my choice but will support me.

[Chasidy 0]

FINALLY APPROVED!!!! Surgery date is 11/20/09! I start my pre-op diet on 11/11/09 but I'm not sure what that will consist of just yet. I'm scared and happy and nervous and excited. I just don't know how to feel!

[PrettyNik 2]

Glad to hear the news Chasidy! I also have Aetna. I'm getting banded 11/06 (this friday)!! Yay for us!

[policy34 0]

hi, was denied by bcbs in reference to diet plan..(6 mos)supervised by a doctor..my doctor put me on phentermine in 12/08..and list my assessments as morbid obesity.and she did not want me to come back each month..I went back to her on 09/2009 and she adv of my weight @ that time as doctor notes and adv that she is agreeing w/me having lapband surgery...I have my progress notes do you think the insurance will except that..our I will need to visit the my doctor once a month for 6 months..:thumbup:

[beckermerj 0]

I also have aetna at first I was denied and told to do six months of nutrition counseling missed one month my grandma had passed away and was told I had to start over so I did that and finished my last month 2 weeks ago and they are sumitting the paperwork again my fingers are crossed I sure hope this all works out for me.. :drool:

[39andholding 0]

Hi Chasidy ! Glad you got it straightened out :thumbup:

My surgery is also Nov 20th. :cursing: