I have been denied!!!!

rroswelltx · March 21, 2006

I hve been denied by Aetna. I can't stand them, they approved my for RNY but I do not want that. I just don't understand it. Trying to keep my chin up and prepare for the appeal battle, but the doctors office says that it is probably futile with Aetna because they just won't approve it. I had all the paperwork and background stuff, I just don't have IBS, stomache adhesions, sclerorsis of the liver and all that junk!!!!! ARGH!!!!

PhotoNut · March 21, 2006

Aww geeze! This really sucks! Well, hang in there and we'll all keep praying for the right thing to happen for you. Keep on trying! Never give up hope! *hugs*

Alexandra · March 21, 2006

Regina, it's always worth fighting for the right. Aetna denied me but I appealed and won--they'd happily have paid for RNY but here I wanted to cost them LESS and they didn't like it. Tough.

Keep appealing; there may be someone on the other end with a brain and all it takes is one. Good luck!!

sleepyjean · March 21, 2006

I think in the long run, banding is actually more expensive than GB - at least in some cases. When I first started looking into this, I wanted to have it done at UCLA. I did a lot of band research on their website and it was only two months later when I finally had all the paperwork to submit, that they said they don't do banding anymore. The woman I spoke to said the band requires too much follow-up care. I understood that to mean that it's too expensive and doing adjustments and stuff is a big pain for surgeons to do.

Magic · March 21, 2006

I think in the long run, banding is actually more expensive than GB.

I think Jean is 100% right, since the band needs maintenance all the times (fill, unfill, fill, unfill) and so on...

I'm not very familiar with US insurance co. But can you ask them to only cover your operation cost, and then you carry the rest of the adjustments fees. I know, it's the best solution, but still better than nothing. Hope that helps and good luck

legallyKristin · March 22, 2006

Actually from what I hear, GB patients average about 10-20 different GB related illnesses per year. A hospital stay or ER visit costs a heck of a lot more than a fill.

Don't give up. When I was doing my research I found out that if they approve the RNY and don't approve the lap-band it's actually A LOT easier to fight them and win. It's when they don't approve ANY obesity related treatment that you're fighting an uphill battle.

Best of luck

:rolleyes: Kristin

fiveholts714 · March 22, 2006

I am so sorry! Make sure that you know the rules of the appeal process. Sometimes you only get 2 chances and they have to be a certain number of months apart. So have all your ducks in a row. Ask them for secifics on why it was denied.