Bellanthin

Approveddddddddd yayyyyyyy

My bmi was 49 with no comorbities and I was initially denied by Aetna twice. I was only required to undergo three months of nutritional counseling but ultimately went though 12 months. I was denied the first time because my surgery was outside of process by 4 days due to a holiday weekend, and told to go through three more months of nutritional supervision.
I'm fought with Aetna for 18 months before hiring a healthcare advocate at great cost, who threatened to sue and go to the media. She also wrote a scathing letter to the Chief Medical Officer stating the same and detailing the huge liability to Aetna based on my medical history. I had a knee replacement, spinal/neurosurgery, and several of procedures which were mostly weight related. i received a call from the medical review and appeals department overturning the denial one week after the letter was received by the CMO. I was finally sleeved on 2/19/13 and I am down 80 lbs so far.

Bella, I am sorry, my response wasn't complete. I had decided to pay out of pocket as I had done everything required from Aetna. I did 'self pay' but kept working thru Lindstrom Advocacy, and after all appeals were denied, it went to an independent board, who approved it, so Aetna has to pay. I am now working with the surgeon and hospital, so they can submit the claims and I will be reimbursed. Apparently, they have 90 days from date of surgery to submit charges. I don't necessarily recommend risking it, but I needed to move forward on this. Either way, I had decided to have the surgery. I feel blessed that I will get my money back. I have about a month to get this resolved. All the billing offices have been helpful in submitting the claim now. If I can answer any questions, please let me know. It is so disappointing when you get a denial! For me, it was getting easier, when the 3rd denial came in. I had already convinced myself, I was making the right choice! I was elated when the independent board finally approved me. Don't give up if this is the right choice for you!

Bella, I was denied 3 times by Aetna. I was so disappointed. I contacted LINDSTROM OBESITY ADVOCACY, and they got involved. After all appeals, it was approved by the independent review. They do charge for their services, but I believe they have an 80% win rate. I had made the decision to pay out of pocket, but ultimately I was approved. Kelley Brown Lindstrom was very helpful, and not pushy at all. It is something to consider. Hope this helps. I know how hard it is to be denied....

You ever get the feeling that they have this number written on a piece of paper, and thats how many they'll approve a month? And if more come in, they just deny them - knowing we'll appeal and try again next month.
Every business has quarterly and annual financials. I wonder how much that comes into play?

Delware county clifton heights 20minutes from south philly

I feel guilty! Y'all are way more deservimg than me and Aetna approved me without any hassel. However, I think the ladies that deal with the insurance at the dr office were awesome. They told me what I would need and we got it done. I only had one little curve ball at the end. Hang in there. I have prayers and confidence the appeal will work. Your doctor should go to bat for you!! Everyone let me know what happens.

Prayers sent your way!

I got denied as well this week! I've been an absolute wreck crying my eyes out:( now onto the appeal process in june. Good luck with you!!!!!!!! Prayers coming your way it's so nerve wracking I know first hand

Wow I've seen so many people say the same thing! Maybe a letter pointing out the pages they are on in the clinical s would help. Or do a BP log and take it to your PCP and have them clearly document it and have them write on or circle the blood work with the cholesterol and sign it. These crazy insurance companies! Maybe if they can't find it by glancing then they say it isn't there. Good luck, I know how you feel about being denied

I was denied by a psychologist. My insurance coordinator didn't submit it to my insurance and I was able to get a second opinion. Fortunately the second psychologist approved me. Could you see about doing it that way? I don't know what your insurance is and all are different. But do you know?

I am praying for you and for me! My appeal got submitted yesterday. Keep your chin up..... We will get through this! Oh I also submitted documentation that they did not request about some of my comorbidities for good measure and wrote a letter. My insurance coordinator helped me with some of the things I could put in so hopefully the will see me as a human NOT a case....

You've got it....I know first hand how a denial feels...AND I know prayers do help since my appeal was approved......so depressing seeing everyone else Celebrate while you are waiting....praying for you!!!

Prayers and good wishes going your way

You got it! I join you in prayer.

I am so sorry! Prayers sent your way.

omg i want thius so much been so depressed im asking every one to say a prayer for me please

omg i want thius so much been so depressed im asking every one to say a prayer for me please

omg i want thius so much been so depressed im asking every one to say a prayer for me please

omg i want thius so much been so depressed im asking every one to say a prayer for me please

omg i want thius so much been so depressed im asking every one to say a prayer for me please

So sorry they did that and you have to go through this...praying for you!

same exact thing happened to me today w atena they said they had no proof of my high blood pressure high colestrasl which was all stated in my clinicals