Appealing- contact your senator!

[KSTUZ 438]

Hello all! I was also denied by Aetna for weight gain. I don't know where u all live, but I was given a lil tip from a friend on sending my appeal into Aetna...

CONTACT YOU STATE REP AND UR STATE SENATOR!! I live in PA, I contacted and emailed Pennsylvania senator Stewart Greenleaf and emailed him my appeal letter on Monday night. Today I was received a call from his office stating that they received my request and sen. Greenleaf was writing a letter on my behalf to Aetna supporting my appeal AND sending it out today!!

I sent my appeal letter in today too...sent by certified mail. I gave it to my 2 sisters, husband, one coworker, and my mother and everyone ended up crying while reading it. Sooooo I'm guessing the letter is better than great!!

Apparently insurance companies DO NOT LIKE THE STATE REPS AND SENATORS involved. HOPEFULLY this will help my appeal!! I'll let u all know if it works!!

[1Day1Life4Now 882]

Good luck. I hope you win your appeal. Insurance should allow these surgeries for most people as it will save them a ton of money in the long run. Losing weight and getting healthy is such an amazing way to live. I wish you the best.

[Baby kitty 7]

I feel your frustration, but in the opposite direction. I've struggled for 20 years now to not be too obese. My BMI is 31,I have PCOS and Metabolic Syndrome, which includes high blood pressure, high cholesterol, and on the last blood test my sugar was at the very top end of "normal." In addition, I had severe gestational diabetes when I was pregnant with my daughter. Because of the PCOS, I had to go to extreme measures just to get pregnant. The gastric sleeve has a very high probability of eliminating most, if not all, of my medical issues. But does that matter to the insurance companies? NO! I'm doing this to save my life down the line, but the insurance companies are punishing me for good behavior. My BMI isn't 35, the imaginary magic number that doesn't mean squat. They think they know more than the medical doctors. They think they are saving money by denying coverage. How stupid! I'm SAVING them a boatload of money by doing this. Unfortunately, I'm forced to do this out of the country. I wish you the best in your fight, and sincerely hope a light can be shined on these people.

[KSTUZ 438]

Thank u both so much, I've had a crazy 6 months, I need this approved so badly. I appreciate all ur kind words

[Rovobay 920]

please keep us updated on your appeal process. I am hoping the best for you!

[fezik23 240]

I had success contacting the state dept of insurance. That was not about wls, but I had my problem resolved within days. Insurance companies do not want to entertain the idea of losing their license to sell insurance. This was in nj.

[haleytrim 244]

Baby Kitty...I feel your frustration. WLS is totally excluded on my State insurance policy. My insulin is costing them over $500. per month, Diabetes pills about $215. 2 BP meds about $275., Cholesterol meds $60-$80 per month, neuropathy meds $30. With an 85% success rate you'd think they could figure out they could have the surgery paid for in about 14 months and save a bundle over the rest of my lifetime. Oh well, Mexico, here I come.

[Josefina1210 12]

@@KSTUZ did they let you know ahead of time that gaining weight during the 6 months would disqualify you?

[KSTUZ 438]

@@KSTUZ did they let you know ahead of time that gaining weight during the 6 months would disqualify you?

No they did not. But it was my job to know the requirements of Aetna. I just had too much on my plate.

[Jersrose43 837]

Why were you denied by Aetna in the first place? The senator may not be able to help if it's an exclusion

[KSTUZ 438]

Why were you denied by Aetna in the first place? The senator may not be able to help if it's an exclusion

I was denied for a net weight gain, But in my defense my 37 yr old husband has a heart attack and also needed a triple bypass. It was so hard on me and while he was in the hospital it was too hard to breathe let alone eat. Which I didn't.

I'm asking them for an exception, I'm trying to get healthy with my husband and I can't keep up with him now...which is a great thing for him.

I know what I did wrong, and I'm hoping they see that I've had a very difficult time the past 6 months. If not-I can do 3 more months of NUT visits. And I intend to continue.

If the senator can't help- than so be it. But I at least put in the effort to continue to fight!!

[Jersrose43 837]

I was denied for a net weight gain, But in my defense my 37 yr old husband has a heart attack and also needed a triple bypass. It was so hard on me and while he was in the hospital it was too hard to breathe let alone eat. Which I didn't. I'm asking them for an exception, I'm trying to get healthy with my husband and I can't keep up with him now...which is a great thing for him. I know what I did wrong, and I'm hoping they see that I've had a very difficult time the past 6 months. If not-I can do 3 more months of NUT visits. And I intend to continue. If the senator can't help- than so be it. But I at least put in the effort to continue to fight!!

I'll think you'll get more out of:

Going through your own appeal and documenting weight loss or steadiness except during those times

Enlisting the department of insurance - scarier than a senator since they know the state regs

Take all appeal levels and if one is offered I person/on phone- take it- be factual, clear and do not show over emption