Denied...Again - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

ashleyw889 · 09-29-2009, 01:53 PM

Aetna denied my appeal. Now I look into getting a loan somewhere so I can pay for the surgery. Ugh!

poet_kelly · 09-29-2009, 01:57 PM

Why was it denied?

Kelly

Jeanie · 09-29-2009, 02:03 PM

Did they tell you why? You can appeal again. I had to appeal twice before I was approved to see the doc.

Toony · 09-29-2009, 02:09 PM

I had to appeal too... don't give up without a fight!

ashleyw889 · 09-29-2009, 02:22 PM

My BMI isn't over 40. It is currently 39.6. I don't have any co-mobidities. I do have arthritis, but I guess they didn't care. I did recently find out from my OB GYN that my glucose levels are high. I don't know why my surgeon didn't pick this up when they did all of their blood work. I need to make an appointment to see my PCP.

I could appeal again, but I'm so tired of waiting. It took a month to find out I was denied again. I'm so tired of being in pain (my knees).

poet_kelly · 09-29-2009, 02:27 PM

Some insurance companies will consider arthritis a comorbidity and some won't. I assume you submitted a letter from the doctor treating you for arthritis stating that losing weight would help the condition?

Without comobidities, they usually will not approve you if your BMI is under 40. Still, it seems it would be worth the effort to appeal again if you can. Also make sure you notify them that your blood glucose is high, although unless you are actually diabetic, they may not consider that a comorbidity either.

Kelly

ashleyw889 · 09-29-2009, 02:31 PM

Yes, I submitted a letter from my doctor saying I had arthritis.

I guess I need to be more patient and wait to see if I have diabetes and then submit again. It is so hard waiting though!

poet_kelly · 09-29-2009, 02:37 PM

This may seem nit-picky, but how was the letter worded? Like, did it just say you have arthritis, or did it specifically say that your arthritis would likely improve a lot if you lost weight? And did it say things like, you would be less likely to need pain medications or cortisone injections or a knee replacement or whatever to treat the arthritis, if you lost weight? Because they may need to see how it helps their bottom line, you know? Pay for weight loss surgery, or pay for knee replacements for arthritis?

Kelly