Skip to content
View in the app

A better way to browse. Learn more.

BariatricPal

A full-screen app on your home screen with push notifications, badges and more.

To install this app on iOS and iPadOS
  1. Tap the Share icon in Safari
  2. Scroll the menu and tap Add to Home Screen.
  3. Tap Add in the top-right corner.
To install this app on Android
  1. Tap the 3-dot menu (⋮) in the top-right corner of the browser.
  2. Tap Add to Home screen or Install app.
  3. Confirm by tapping Install.

Join BariatricPal free

  • Ask your own questions
  • Reply and follow topics
  • Message other members
  • No cost, no spam

Denied by aetna any advice?

So I was denied because atena is looking at my medical records from 4 years ago ( I recently got insurance back so I haven't been at the doctors) in that mean time I gained back 70 lbs and was diagnosed with PCOS and countless other issues so now they think I'm "skinny" when I'm bmi 43 and 278lbs! Now I have to go through this appeal process uhg and get doctor letters and stuff my bmi has fluctuated between 38-43 I'm so nervous they will deny me again!!!! Any advice? Has anyone else been denied too for this issue? Or their bmi but still was approved!???? !! I'm terrified right now

  • Replies 14
  • Views 1.2k
  • Created
  • Last Reply

Featured Replies

Go to Mexico

I have Aetnea POS and they flat out won;t do it.

So I was like F you and wen tot Mexico. BEST decision of my life.

  • Author

I have polycystic ovarian syndrome which is triggered worse by my weight, I can't have kids because of it, my cysts rupture everyday, my knees and hip dislocates , I'm flat flooded with a bad back, constant migraines and headaches from my PCOS , pre diabetic not to mention hypertension, heart disease and morbid obesity runs crazy in my family like 500+ lbs!!! I'm on depo and other pills to control my PCOS which ha caused me to gain SO Much weight! I can't work out like I'd like because I'm in so much pain.. Wonder if they'll take that into consideration and it'll be enough! :( I've never been below 200 in my life so it's not like I just got fat ya know :( if I don't get this I am doomed idk what I'm going to do :(

Well... I have fluctuated the last 2 years between 38-40 BMI. Aetna approved me because I have obstructive sleep apnea. Not all obese people have sleep apnea but it wouldn't hurt to get a sleep study done to rule it out. Many people have gone to get surgery down in Mexico but you need to be careful which surgery practice [and surgeon] you go for. Make a well informed decision. Wishing you the best, PCOS is awful.

I would check with your surgeon to see if he would do a peer review with the insurance company, which basically your surgeon explains to them why you should have the surgery.

  • Author

I don't think I'd ever go to Mexico or my family would allow it... And yes i just about this peer thing I'm totally gonna talk to my surgeon an see what he says

  • 1 month later...

I have Aetna. They had a 3-6 month multi disciplinary regimen to follow. They asked for a two year history of weight tracking, my Rhuemy had it. No issues with coverage at all. Feel free to message me.

Also, they have clinical policy bulletin you can find and print. Gives you their entire requirement crap for coverage.

I would try to find a doctor who has a track record of success with insurance companies.

That's ridiculous that you're being denied. Good luck.

I don't think I'd ever go to Mexico or my family would allow it... And yes i just about this peer thing I'm totally gonna talk to my surgeon an see what he says

Hi, I have Aetna too, and they kept requesting more information, but, I think if you (and your surgeon's coordinator) are persistent, you can be successful! Hang in there and good luck!

Aetna only needed 2 years of weight history from me. 4 years seems kinda weird. I had no co-morbidities, but my BMI was well over 40 and I was approved. Good luck in getting them to approve this!

Sent from my iPhone using VST

So I was denied because atena is looking at my medical records from 4 years ago ( I recently got insurance back so I haven't been at the doctors) in that mean time I gained back 70 lbs and was diagnosed with PCOS and countless other issues so now they think I'm "skinny" when I'm bmi 43 and 278lbs! Now I have to go through this appeal process uhg and get doctor letters and stuff my bmi has fluctuated between 38-43 I'm so nervous they will deny me again!!!! Any advice? Has anyone else been denied too for this issue? Or their bmi but still was approved!???? !! I'm terrified right now

You can re submit it 3 times &usually get spproved. It c as lled a rebutal/just paperwork

I have polycystic ovarian syndrome which is triggered worse by my weight' date=' I can't have kids because of it, my cysts rupture everyday, my knees and hip dislocates , I'm flat flooded with a bad back, constant migraines and headaches from my PCOS , pre diabetic not to mention hypertension, heart disease and morbid obesity runs crazy in my family like 500+ lbs!!! I'm on depo and other pills to control my PCOS which ha caused me to gain SO Much weight! I can't work out like I'd like because I'm in so much pain.. Wonder if they'll take that into consideration and it'll be enough! <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/sad.png' class='bbc_emoticon' alt=':(' /> I've never been below 200 in my life so it's not like I just got fat ya know <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/sad.png' class='bbc_emoticon' alt=':(' /> if I don't get this I am doomed idk what I'm going to do <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/sad.png' class='bbc_emoticon' alt=':(' />[/quote']

You will have no problem being sleeved. U have HBO and that is a com morbidity. :)

Archived

This topic is now archived and is closed to further replies.

Account

Navigation

Search

Search

Configure browser push notifications

Chrome (Android)
  1. Tap the lock icon next to the address bar.
  2. Tap Permissions → Notifications.
  3. Adjust your preference.
Chrome (Desktop)
  1. Click the padlock icon in the address bar.
  2. Select Site settings.
  3. Find Notifications and adjust your preference.