I am freaking out on the inside,but trying to look calm to everyone around me. I went through a three month program of psyc eval, dietician, supervised 1200 cal a day diet. After my last weigh in I was told by my Dr's office everything had been submitted and two weeks later I get my letter denying coverage. The reason is because Aetna said they didn't receive any proof of medical necessity. My Dr's office didn't meet the dead line.

The appeal has been filed. I am ????

I have Aetna but I never knew of a deadline...are you sure that was the real reason for denial?

Deadline for what? For medical necessity, they need to show you have at least the BMI that Aetna requires with no comorbidities, or the lower BMI with the comorbidities.

Sounds to me like your doctor didn't write the letter of recommendation stating it is medically needed. I've had to wait since Oct 5th to get my surgeon to write one because he was out of town and out of the office all that time. Without one, it's an auto denial even though they don't list it in the requirements. I was dumbfounded when I found out we had to have one otherwise I would have been on them weeks before I finished to get it done.

According to the insurance coordinator at my Dr's office she was told by Aetna that she missed a 72 hour deadline to have all of my clinical info faxed to them. Which doesn't make sense because she submitted on a thursday and I was denied the next day. Aetna told me they denied it because they had received no proof of medical necessity. The IC said she had never had this happen before. So... I am not sure what to believe! But I didn't get a letter of medical necessity from my GP because I was told with my bmi and co morbidity I didn't need it.

I am wondering if I should get a letter from my doctor anyway. The insurance coordinator said they had already filed an appeal though...so maybe it is too late.

I was told by Aetna and my Dr's office I didn't need one because my bmi is so high. Do you think i should get one anyway?

Couldn't hurt to have one. Definitely appeal!

I want to call Aetna and bug them...but I don't want to interfere with what the insurance coordinator is doing. But I really want to call.

Called Aetna and they say my appeal should be decided by Nov 4th.

As far as the time limit on the turn around? They said it was 24 hours my surgeon's office submitted everything on the same day. So they are really just being dishonest. The rep with the precertification department was so rude...she wouldn't let me speak and intterupted me constantly. I am sooooo frustrated right now! This never should have been denied...and all I can do now is wait.

I really hope it goes your way. Hang in there!

Thank you!!

I'm sorry this is happening to you I hate dealing with Aetna I work in a psychiatrist office and every time we deal with them I want to kill the person on the other end I always get the run around

Lol that is exactly what it has been! So much conflicting information! I finally was able to get them to say Texas law states there is a 72 hour turn around time. My clinicals were requested 10/16 at 3:07 they were faxed at 3:30 and I was denied at 4:39 so there basis of denial being that they didnt receive clinicals before I was denied by the medical director is a total lie. So after several hours of being on hold and speaking to everyone's supervisor, the nurse is calling me in the morning! I realize they won't overturn the denial but I am going to ask that my appeal be expedited due to their "mistake".

Oh and my durn profile pic is crooked and I cant get it to flip. *Big Sigh* even the little stuff is getting to me now! Lol

Well the nurse from Aetna called this morning. She said that even though Texas requires a 72 hour turn around because my info was submitted on a Fri it had to be in be noon. So I guess they get to make the rules up as they go along. I am going to wait and see what happens with my appeal and then look into an IRO if I get denied again.