Impatiently waiting for Aetna

[nh20013 15]

Yes I just speak to a rep in member services they are usually very nice and will look up your info to give you a status. Turns out what they told me was correct! I received a letter from Aetna today letting me know my appeal was received and it's going to be reviewed on 10/22 at 10:30 am once reviewed they will send me a letter within 5 business days with their decision, so its great to have a timeframe.

[mazzers120 75]

Yes I just speak to a rep in member services they are usually very nice and will look up your info to give you a status. Turns out what they told me was correct! I received a letter from Aetna today letting me know my appeal was received and it's going to be reviewed on 10/22 at 10:30 am once reviewed they will send me a letter within 5 business days with their decision' date=' so its great to have a timeframe.[/quote']

Thanks! Maybe I'm being impatient, I started this process in July. My surgeons office said the approval process normally is not this difficult and time consuming, but it seems like a lot of people here are dealing with this.

[shelley_38 10]

Thanks! Maybe I'm being impatient' date=' I started this process in July. My surgeons office said the approval process normally is not this difficult and time consuming, but it seems like a lot of people here are dealing with this.[/quote']

When I spoke to Aetna they told me that I should speak with someone in the precertification Dept and will be able to tell me whether or not I got approved

[Bellanthin 112]

Does anyone out there have Aetna? I have a BMI of 39.4' date=' but still waiting to see if I have sleep apnea. I've completed all other requirements for surgery. Does anyone else have Aetna? Were you able to get approved? So frustrated and ready to go! Treatment shouldn't be dictated by my insurance, it should be dictated by a doctor! Grrrr![/quote']atena is horrible

[Bellanthin 112]

I have Aetna and was approved. When my case was submitted' date=' my BMI was exactly 40. I had none of Aetna's listed comorbidities (diabetes, sleep apnea, high blood pressure, etc). Nor did my weight history indicate a BMI of 40+ for two years. (It was 40 one year and 38 another.) I do, however, have sever osteoarthritis/degenerative joint disease in my knees because of years of being overweight. My orthopedist wrote me a letter of medical necessity for surgery. Additionally, I wrote a personal narrative and had it included in my file that was submitted to Aetna. My narrative/letter detailed my lifelong struggle with weight from my earliest memory at age 5. It chronicled every diet I'd ever been on, including my first Weight Watchers meeting at age 8, and Fen-Phen/Redux at age 16. When the Aetna nurse called me, she said, "I read your letter and wanted to tell you myself that you're approved." I was told by the bariatric coordinator at my surgeon's office that approval really comes down to whoever is reviewing your case. Luckily, I tugged on that nurse's heart strings. My story was a compelling one that outlined my family history and my plea to not be another broken branch on that tree.[/quote']it all depends on your employer

[Bellanthin 112]

What do you have to include when your doing an appeal? Did your surgeon do a peer-to-peer review with the medical director before having to do an appeal? Wanted to get a jump start in case I get denied. Thanks for any information anyone can give me!

. Write a letter Tell why u feel u should have surgery, have surgeon write letter why he feels it's medically necessary ,send all paper work in your file .,tell them if your not happy w their decision u will be going to The insurance commissioner, your lawyer, n the news . No insurance company wants u to tell how bad they r on tv.add family history in letter

[Bellanthin 112]

Thanks! Maybe I'm being impatient' date=' I started this process in July. My surgeons office said the approval process normally is not this difficult and time consuming, but it seems like a lot of people here are dealing with this.[/quote']i did .... But I didn't give up they want u toooo do notttttttt give up fight

[mazzers120 75]

i did .... But I didn't give up they want u toooo do notttttttt give up fight

How long did you go through the process

[Bellanthin 112]

How long did you go through the process

started February first surgery was supposed to be in May they denied me day before surgery fraught and won surgery was aug 7th

[Bellanthin 112]

How long did you go through the process

if your waiting this long you will probably get denied so work on that letter I'm telling u they r doing this so u will give up they lied saying they had no proof of My bmi My high blood pressure high cholesterol They knew damn well they had all the proof there

[mazzers120 75]

if your waiting this long you will probably get denied so work on that letter I'm telling u they r doing this so u will give up they lied saying they had no proof of My bmi My high blood pressure high cholesterol They knew damn well they had all the proof there

They have came with in 24 hours two times requiring more tests this time theybhave been medically reviewing it for almost two weeks now. On a good note the team at my surgeons office is great they are willing to help me fight

[Sara UAE 0]

Well, Aetna Denied me. they said it's because of the 39 BMI. (this was taken 3 months ago )

i'm trying to appeal now. my current BMI is 41 and i got a letter that shows that i have asthma.

also i'm doing a sleep apnea study. i'm really mad at my ins coordinator.. she didn't mention the sleep apnea thing.

does anyone know if it's possible to change the BMI to my current one so i can win the appeal and get an approval ?

[mazzers120 75]

Well' date=' Aetna Denied me. they said it's because of the 39 BMI. (this was taken 3 months ago )

i'm trying to appeal now. my current BMI is 41 and i got a letter that shows that i have asthma.

also i'm doing a sleep apnea study. i'm really mad at my ins coordinator.. she didn't mention the sleep apnea thing.

does anyone know if it's possible to change the BMI to my current one so i can win the appeal and get an approval ? [/quote']

Well if u can come up with the co-morbidities that should work?

[Sara UAE 0]

Well if u can come up with the co-morbidities that should work?

yeah that's what they said.

i'm waiting for my sleep apnea study.

*fingers crossed*

[nh20013 15]

So I contacted the person conducting my appeal tomorrow at 10:30 and advised I do want to join in via conference call. I am so nervous I couldn't sleep at all last night!! I have been waiting so long I'm sick over this!

I have Aetna at time of 1st submission I was at 40 BMI with one comorbid of HPT but the previous two yrs had been under 40 with no comorbids so I was denied. Since my denial I went and had sleep study and have sleep apnea so now am at 40 with 2 comorbids let's see what they say! Wish me luck guys!!!!