Aetna ***

[NWB8 10]

Oh wow, well i did send out my Appeal letter now just waiting on a response and hopefully it's a good one if not then I guess it's appeal number 2 and if not it's the external review. Can you explain to me what the external one is? I'm not 100% what it is . Thank you

[dede0314 356]

Its basically Aetna has third parties to review your information. So they are not Aetna employees. When I got my decision letter the external review it looked very basic it had three questions. Was the surgery excluded from my plan? Was the requested service experimental? And was it medically necessary based on my plan? So basically did I meet the requirements? Which I did solely based on my BMI. I also hired Lindstrom Obesity Advocacy to file my appeal.

[NWB8 10]

Ohhhhh ok thank you for that information.

[stacyrg2 350]

In California, once you exhaust your internal appeals with your insurance Company, you can ask for an Independent Medical Review with the Department of Insurance. They take info you submit, as for information from the insurance company and have an independent panel of doctors review the decision. I'm currently going through the process right now. I have Aetna and they denied a non-surgical treatment for severe GERD that occurred after my Sleeve. I've had a few insurance companies and Aetna is by far the worst one to deal with.

[NWB8 10]

Yes they are the worst. Good Luck

[NWB8 10]

GREAT NEWS MY APPEAL LETTER WORKED AND AETNA APPROVED THE SURGERY. WHOOP WHOOP!!!! Soooo happy you guys know that feeling right? when things don't go your way the 1st time and then you try and pray and you finally get that YES.!!! Surgery will be mid june.

[Luckysgirl1909 2]

GREAT NEWS MY APPEAL LETTER WORKED AND AETNA APPROVED THE SURGERY. WHOOP WHOOP!!!! Soooo happy you guys know that feeling right? when things don't go your way the 1st time and then you try and pray and you finally get that YES.!!! Surgery will be mid june.

Omg that is awesome! Im soooooo happy for you. ... and they changed there mind pretty dam quick too. Well that makea me feel a little more positove should they turn me down. What made them change there mind? Are u 25-36 bmi like me? Mind if I ask what comorbidities thwy found in tou ro gwt approved? Only thing i have they dound is a hernia in my stomach, mild alwep apnea... no machine and high cholesterol. . Like 297 high. They just put me on meds for it. Praying thats enough. Reat of my blood work is making me border kine for high bo and diabetes ao hopefully they take that into account also... praying everyday! ! Lol

Jennifer

[NWB8 10]

Hello. Well my BMI is 41.2 and i'm boarder line diabetic, knee and back problems and i wrote a hell of an appeal letter wrote it from my heart so maybe they toke that into consideration and being a single mom. I will say a prayer for you and hope you get a good outcome. Please keep me updated if you get approved

[Luckysgirl1909 2]

Hello. Well my BMI is 41.2 and i'm boarder line diabetic, knee and back problems and i wrote a hell of an appeal letter wrote it from my heart so maybe they toke that into consideration and being a single mom. I will say a prayer for you and hope you get a good outcome. Please keep me updated if you get approved

Thanks sweetie! Yeah im crossing my fingers but, whats ment to be will be if anything I will try and go the appeal route. Thanks for all the help and info. So happy for you keep me posted on how your doing chickie

Jennifer

[NWB8 10]

Oh you are very welcome and i will keep you posted. Just think positive if you need anything else you know where to find me.

[Womanvsmirror 314]

Congrats @NWB8 Do you mind if not here than via pm sharing your appeal letter? Thinking positive of course I'm hoping its not needed but Aetna received my request on Monday, and its currently still pending. on one of my nutritionist visits(not on of my regular weigh ins) I went up 1lb then by my actual weigh in I was down 7lbs...not sure if that other visit counts at all but a tad bit concerned. I was hoping for a May date but as my surgeons schedule is filling fast if I can get approve in the next few days I can at least get an early June date

[KristenLe 5,980]

Obesity Action Coalition has good appeal letter examples.

[NWB8 10]

Any luck with the insurance approval?

We Can Do This!!!

[NikkiRT 265]

I just went through this entire thread, because I have Aetna as well, which is sponsored through my employer. I have read through all the documents on the requirements, and I am not seeing anywhere that is states there can not be weight gain through the process. Is this something that your surgeon advised you of? I just don't want any suprises:)

[dede0314 356]

Maybe your plan is different. But its in the requirements here:

http://www.aetna.com/cpb/medical/data/100_199/0157.html

Edited June 27, 2016 by dede0314