How long does an appeal take w/Aetna? - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

adagirl · 10-09-2009, 05:20 PM

I just mailed my appeal today. The original denial only took one week. Has anyone done an appeal w/Aetna before and how long did it take to get a response?

Sherry_Lynn · 10-09-2009, 09:53 PM

I can't answer your question, but I'm pretty sure it's such an individual process. We all have such different policies and requirements. Just don't give up!

FatButNotHappy · 10-10-2009, 03:54 AM

I did an appeal with Aetna and it took about three weeks, I think. Oh and by the way--I WON, in case I forgot to post it anywhere.

I believe it was sent to them around sept 14 and i got the letter Oct 2. Hmmm, maybe that is only two weeks? Well, it seemed like two months. But, it was worth it.

I had my surgeon's office send it all in.

Why were you denied in the first place? Good luck with the appeal. I hope it works out for you, too.

adagirl · 10-10-2009, 12:04 PM

Hey Stacie! I have actually read a lot of your posts already because I did a search on 'Aetna' and 'appeal'. LOL Your experience w/Aetna has given me a lot of hope. My situation is somewhat similar to yours. Aetna says I haven't been fat enough for long enough cause my 2007 weight is too low. I know I can just resubmit in January and it would be approved. I was even thinking about just doing that as I had sat on my denial 3 months already... feeling a little depressed about it and doubting myself some, also just trying to get my head wrapped around the whole weightloss surgery thing. But, on Monday I went to the doctor and got some lab results which resulted on me being put on Crestor (for high cholesterol) and being told I also have pre-diabetes. Also, my weight is up and now I'm a 40 BMI. With my previous submit to insurance I met the requirements of 35+ BMI w/two co-morbids (medicated, but uncontrolled high bp and obstructive sleep apnea requiring a CPAP... which I don't really use cause I hate it).

Anyways, now I've got a 40 BMI and FOUR serious conditions. I know Aetna doesn't even count the high cholesterol and pre-diabetes, but it was enough to scare me into appealing this and trying to get the surgery sooner rather than later. My case to them is that I can show 35+ BMI w/high bp as far back as 2002. The only reason my BMI was lower in 2007 is because I was having some success on weight watchers. Anyways, this insurance stuff can make you crazy. You are damned if you do (diet - if your BMI drops too low) and damned if you don't (diet - cause you have to show you attempted it). Oh well, but at this point its just a matter of timing. I would love to have this surgery before the major holidays because I really don't need to let myself get into any 'last supper' mentality. And, you know my 'last supper' would be the entire rest of the year. LOL

FatButNotHappy · 10-10-2009, 12:09 PM

I was going to wait and reapply in january too. they would not be able to deny me then, either. But, I wrote a three page letter...basically begging them to use their heads and realize how stupid it would be for them NOT to pay for the surgery now and I guess it must have worked.

In the letter they sent to me explaining that they were going to pay it said something about them not having all of the info during my first attempt, so i am wondering if my surgeons office dropped the ball and didnt include all of the right stuff. OR if Aetna was just blowing smoke?

Good luck with your appeal, i never thought in a million years that mine was going to work. Just keep your fingers crossed.

adagirl · 10-10-2009, 06:30 PM

My appeal was 3 pages too. Hopefully that is the magic number! My favorite sentence in the appeal... 'As I'm sure you are aware, it is not uncommon for an obese person to be able to lose a considerable amount of weight, but then not be able to maintain that weight loss long-term.' in reference to my lower Weight Watchers weight in 2007. Duhhhhhh!!!

Anyway, I'm feeling pretty good about it. I really feel like I made the best case I could make in my appeal. If it's not good enough, then on to January it will be. You would think they would want to just go ahead and approve it to save the administration costs of having to review all of it again in January. LOL

adagirl · 10-22-2009, 10:54 AM

Update... I emailed Aetna Member Services to see if a decision had been made yet on my appeal and just heard back that they decided to uphold the original decision. So, I am still DENIED! Ugh!!!

I feel really sad about that. I just want to get on with this. Now I will just have to re-apply in January when my 2007 weight won't matter anymore.

In the meantime, I'm gonna try to get back to the healthy changes that my nutritionist was working w/me on during the 6 month diet. After I got denied, I've just been lazy about all of that for the past 3 months. I've been kind of wallowing in a bit of self-pity I guess and its doing me no good at all. I've gained a lot of extra weight in just those few months that I let it all go.

Maybe I will start seeing a therapist until I can submit again. That way I can charge Aetna for SOMETHING. Muahahhahahahahhahaa!!!

poet_kelly · 10-22-2009, 10:55 AM

I'm sorry to hear that. Fortunately, January is not that far away now. Hopefully things will go quickly after that.

Kelly

ashleyw889 · 10-22-2009, 11:09 AM

I'm so sorry that you got denied. I got denied too. I really dislike Aetna right now.

dswofford · 10-22-2009, 11:10 AM

Quote:

Originally Posted by adagirl

I feel really sad about that. I just want to get on with this. Now I will just have to re-apply in January when my 2007 weight won't matter anymore.

Maybe I will start seeing a therapist until I can submit again. That way I can charge Aetna for SOMETHING. Muahahhahahahahhahaa!!!

I am sorry they are giving you a hard time. Aetna.. what else can be said?

Therapist, good... no GREAT idea! I think everyone should have a therapist.