Hi Everyone *excuse my english*

Aetna denied me last week and i'm trying to appeal now.

the reason of the denial was because of my BMI . 39 with no comorbidities.

so now i got a letter from my pulmonologist to show that i have asthma

i scheduled a sleep apnea test.

actually i gained wight after my paperwork was submitted.

so i'm wondering if i can appeal with my current wight ? *which is going to change the bmi to 41*

any advise to get the approval ?

Edited October 22, 201312 yr by Sara UAE

Add the wt with dr. Office visit to prove it.

WTH!!! I'm sorry that's just ridiculous. You would think they would approve it to prevent further illness or complications in the future. How is your blood pressure and or diabetic status? I would think asthma would help to get it approved. Good luck, I hope it works out.

Same here was denied and appealed and got denied. Reweight put my bmi to 41 resubmitted and got denied a 3rd time. Im so frustrated and upset. Im thinking of changing insurance companies.

Find out why they denied you. It could be something as simple as a little paper work.

I was denied as well. I am very confused. They say my bmi is too low. It has been 41-43 for 2.5 years and I have moderate sleep apnea. The girl that handles the insurance is on medical leave so there is no one to re-submit in the two weeks I have. I am sad and frustrated.

Add the wt with dr. Office visit to prove it.

i'm going to the dr office tomorrow. and will see.

WTH!!! I'm sorry that's just ridiculous. You would think they would approve it to prevent further illness or complications in the future. How is your blood pressure and or diabetic status? I would think asthma would help to get it approved. Good luck, I hope it works out.

Thanks, "ou would think they would approve it to prevent further illness or complications in the future" that's exactly what i told them ugh!

Same here was denied and appealed and got denied. Reweight put my bmi to 41 resubmitted and got denied a 3rd time. Im so frustrated and upset. Im thinking of changing insurance companies.

Aetna sucks!!! good luck

Find out why they denied you. It could be something as simple as a little paper work.

i got the denial letter in mail right after i called them .. it said because of the BMI ( 39 )

I was denied as well. I am very confused. They say my bmi is too low. It has been 41-43 for 2.5 years and I have moderate sleep apnea. The girl that handles the insurance is on medical leave so there is no one to re-submit in the two weeks I have. I am sad and frustrated.

WHAT! you should've been approved. go and fight don't give up

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i'm having a sleep apnea test tonight.

they told me i'll know the result in 10 days ( it's likes 10 weeks for me, i can't wait to appeal and fight Aetna )

I was denied as well. I am very confused. They say my bmi is too low. It has been 41-43 for 2.5 years and I have moderate sleep apnea. The girl that handles the insurance is on medical leave so there is no one to re-submit in the two weeks I have. I am sad and frustrated.

Should sleep apnea be enough since you have a low BMI. You should directly call your insurance.

I have Aetna and after two submissions I was approved. However they are getting very very picky. The denial came because they said I needed 1 more appt with a NUT. So I had to go to the office for them to get my weight and blood pressure and temp. Yes vitals and for my NUT to revise her letter of advocation for me to include 120 days of a guided diet.

My bmi was 44 and I have (had) type 2 diabetes.

Sometimes it's something as little as one day of nutrition classes. That didn't meet their requirement that will get a denial

You can appeal the decision with a letter written by you. I've heard that works really well sometimes. Never give up hope, 3 years ago I had blue shield blue cross of Georgia and they denied me 3 times saying my blood pressure was too good and my diabetes wasn't a good enough reason to approve me. So when's company switched to Aetna I tried again...

Good luck and appeal if you need to

WHAT! you should've been approved. go and fight don't give up

-------------------

i'm having a sleep apnea test tonight.

they told me i'll know the result in 10 days ( it's likes 10 weeks for me' date=' i can't wait to appeal and fight Aetna )[/quote']

How was your sleep study? My doctors office has already set up a peer to peer meeting so we will see. I am trying to be positive.

I have Aetna and after two submissions I was approved. However they are getting very very picky. The denial came because they said I needed 1 more appt with a NUT. So I had to go to the office for them to get my weight and blood pressure and temp. Yes vitals and for my NUT to revise her letter of advocation for me to include 120 days of a guided diet.

My bmi was 44 and I have (had) type 2 diabetes.

Sometimes it's something as little as one day of nutrition classes. That didn't meet their requirement that will get a denial

You can appeal the decision with a letter written by you. I've heard that works really well sometimes. Never give up hope' date=' 3 years ago I had blue shield blue cross of Georgia and they denied me 3 times saying my blood pressure was too good and my diabetes wasn't a good enough reason to approve me. So when's company switched to Aetna I tried again...

Good luck and appeal if you need to

[/quote']

Thank you for sharing, it really helps to know others have gone thru the same thing and emerged triumphant.

I guess I didn't expect to be denied, so it threw me for as loop when I was. Now I realize it may be par for the course and learn what needs to be done, and fix any little discrepancies that may have caused the denial.

Should sleep apnea be enough since you have a low BMI. You should directly call your insurance.

Thanks Nesa, I called today. Seems I need two comorbidities and my Apnea (I wake 100 times per hour) is not severe enough. I have hypertension and am pre-diabetic. So we r doing more tests to see if I have moved to the diabetic side. Thanks for the tip. :-)

Good luck.

thank you guys for being supportive.

found out today that i don't have sleep apnea.

i'm going to appeal with my current wight ( BMI 41 ) and asthma

hope it works out.

Thank you for sharing' date=' it really helps to know others have gone thru the same thing and emerged triumphant.

I guess I didn't expect to be denied, so it threw me for as loop when I was. Now I realize it may be par for the course and learn what needs to be done, and fix any little discrepancies that may have caused the denial.[/quote']

Never give up. Appeal it. Use phrases like sleep apnea alone scares me. I want to be alive to see my family grow. I've been dieting my whole life trying to be healthy and this is hope that I can achieve that.

A friend of mine wrote an appeal and hers got approved and it came from a place of struggle and heartache

Never give up. Appeal it. Use phrases like sleep apnea alone scares me. I want to be alive to see my family grow. I've been dieting my whole life trying to be healthy and this is hope that I can achieve that.

A friend of mine wrote an appeal and hers got approved and it came from a place of struggle and heartache

Thanks Italian-girl, the doc did not mention adding a personal letter to appeal. I will definitely do that. I need back surgery and at this weight the surgery would be very invasive (front and back incisions, with 2 surgeons) if I lose weight the surgery options open up. I am in horrific pain everyday. I have pre-diabetes, sleep apnea and high bp. I am scared, I have an 8 y/o autistic son and fear I won't be there to help him when he is older. He is high functioning, but that is with constant therapy and support. I am an only child and both my parents are gone. I will start the letter tomorrow, along with the letter with my son's diagnosis. Thx :-)