Aetna Denial

Sandraj · February 1, 2016

I have aetna, I did not do the physician administered diet and exercise requirement, but was diagnose wit CHF in April 2015 and have been on a diet and exercise regiment since then. My cardiologist wrote a letter stating this and explaining that this surgery is medically necessary. Of course because this plan was to help my heart not to get approval on weight loss surgery it is not documented as need. I submitted it anyway to Aetna for pre-certification on 01/22 i found out today I was denied I have a BMI of 40 and sleep apnea, CHF, and now borderline diabetic. I have now wrote a letter to Aetna which I faxed today hoping they will reverse their decision. Any ideas on possibility of this????

kthompson984 · February 3, 2016

My surgeon's office said that the letter of need for surgery must come from them and not another dr and I am with Aetna. I must do a 3 month supervised plan through them and then they will send the documentation that it is necessary to Aetna for approval.

1excited · February 18, 2016

I have aetna, I did not do the physician administered diet and exercise requirement, but was diagnose wit CHF in April 2015 and have been on a diet and exercise regiment since then. My cardiologist wrote a letter stating this and explaining that this surgery is medically necessary. Of course because this plan was to help my heart not to get approval on weight loss surgery it is not documented as need. I submitted it anyway to Aetna for pre-certification on 01/22 i found out today I was denied I have a BMI of 40 and sleep apnea, CHF, and now borderline diabetic. I have now wrote a letter to Aetna which I faxed today hoping they will reverse their decision. Any ideas on possibility of this????

did you Aetna overturn your denial?