Aetna Denied Me - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

ashleyw889 · 08-26-2009, 12:15 PM

I am so dperessed right now. I was just told that Aetna denied my surgery because I haven't had a BMI over 40 for the past five years. I jumped through all of their hoops with the 3 month diet, etc.

My doctor told me to write a letter stating my case so that they can appeal the decision. I don't know if it will make a difference though.

I have a two year old. Right now, I can't keep up with him. He wears me out. If we go to the park, all I can think about is sitting down because my knees hurts so bad. I want to be able to chase him around! I was recently diagnosed with Arthritis in my knees. I'm hoping once I send a letter to Aetna from my PCP which shows I have Arthritis, that will make a difference. I'm so heartbroken. I just want to be able to play and keep up with my two year old. I felt if I had the surgery, I would get the weight off and be healthy for my son.

I'm also going to get my counselor to write a letter to Aetna. I plan to fight this as long as I can.

But right now...it just hurts so much.

poet_kelly · 08-26-2009, 12:30 PM

I'm sorry you got denied. Unfortunately, most insurance companies require that you have a BMI of above 40 for a period of time, sometimes two years, sometimes five years. Certainly you can appeal, and I wish you luck with that. But if that is their requirement, I'm not sure how successful an appeal is likely to be. You may have to wait and see if your BMI continues to be this high for a while so that you would qualify.

Kelly

UndercoverDiva · 08-26-2009, 12:45 PM

Ashley, if you do a search on insurance denials, you'll find quite a few who also got denied by Aetna, but eventually got approval via the appeals process. Not everyone is successful, but more than a few have been. Just keep plugging away, using any avenue available to you to get your approval. Good luck!

ashleyw889 · 08-26-2009, 01:18 PM

Thank you both. I do plan to keep plugging away. I may be fighting a battle I can't win, but I have to at least give it my best shot.

Thanks for the suggestion on searching on denials! I will do that!

Native2u · 08-26-2009, 01:21 PM

Quote:

Originally Posted by ashleyw889

I am so dperessed right now. I was just told that Aetna denied my surgery because I haven't had a BMI over 40 for the past five years. I jumped through all of their hoops with the 3 month diet, etc.

My doctor told me to write a letter stating my case so that they can appeal the decision. I don't know if it will make a difference though.

I have a two year old. Right now, I can't keep up with him. He wears me out. If we go to the park, all I can think about is sitting down because my knees hurts so bad. I want to be able to chase him around! I was recently diagnosed with Arthritis in my knees. I'm hoping once I send a letter to Aetna from my PCP which shows I have Arthritis, that will make a difference. I'm so heartbroken. I just want to be able to play and keep up with my two year old. I felt if I had the surgery, I would get the weight off and be healthy for my son.

I'm also going to get my counselor to write a letter to Aetna. I plan to fight this as long as I can.

But right now...it just hurts so much.

I just returned your PM.

usairdebw · 08-26-2009, 02:02 PM

I had similar experience with BC BS and won on my 3rd appeal.....dont give up. Now I am doing great and feeling almost normal again.

Best of Luck to you.

joy1968 · 08-26-2009, 02:52 PM

Ashley, I'm so sorry you were denied. Like one of the posters said, it seems Aetna likes to deny cases the first time they are submitted but then after an appeal they approve. Its a ridiculous and annoying process Aetna likes to put people through.

ashleyw889 · 08-26-2009, 07:06 PM

I can't thank you all enough for the encouraging words. I am so glad that I found this group. I can really use the support right now.

Laureate · 08-26-2009, 07:12 PM

Ashley, I'm so glad you not are letting them break your spirit!

And don't forget, document any "co-morbidities" you might have. A lot of common ones are acid reflux, hypertension, diabetes, knee and back pain (arthritis) sleep apnea, high cholestrol.

That can help your case.

Hang in there. You have to fight for this.

Terri

Sherry_Lynn · 08-27-2009, 12:51 AM

I'm so sorry you have been denied. I know the heartbreak, being denied twice myself. I was finally approved, but I still remember the defeat I felt. Hang in there, appeal.