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Received message with the net weight gain photo but doing more research and found out by talking with dr office today and they said I did not gain , I actually lost weight start 6/2015 240lb to 9/2015 at 239.5 so I'm not sure what is going on. Maybe Bec The dr office submitted my paperwork to insurance comp two weeks after the 6 month deadline to schedule my surgery , I have no idea.

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This is BS! Anything to avoid paying! Fight!

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What exactly did your denial letter say?

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I also used lindstrom. Had to go through to the external appeal but won in the end. Don't give up

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post-296995-14696625604218_thumb.jpg

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I hope you can read it !

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@@dede0314 thank you.

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@@KristenLe thanks

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Oh and by the way , Aetna (case manager) said I am only allowed one level appeal and external review is not allowed under my plan

So I did a little digging and pulled up my benefits and researched , then called Aetna and was told a different story.

I am allowed an external appeal and my denial letter indicate that I am allowed not only one but two appeals plus an external review. This is unbelievable !!!!

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Insurance companies expect your monthly premiums on time but they surely put you through hell to have them pay for something that is covered under your benefit plan.

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Wow! My doctor's office told me that with Aetna weight gain is a huge deal. Even half a pound would get you denied. I was recently told that the time frame is a huge deal too. I was told I had to schedule appts 31-35 days apart, including weekends. If you go out of those date ranges, they will require you to do the 6 months instead of 3.

On another forum, I saw where a lady gained and Aetna didn't deny or approve her, they just made her do an extra 2 months and she had to lose weight, not gain or maintain.

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attachicon.gif ImageUploadedByBariatricPal1469662552.370969.jpg

Sent from my iPhone using the BariatricPal App

I hope you can read it !

Sent from my iPhone using the BariatricPal App

@@dede0314 thank you.

Sent from my iPhone using the BariatricPal App

@@KristenLe thanks

Sent from my iPhone using the BariatricPal App

Looks like you were denied solely because you gained weight. It says you don't meet both criteria. I'm assuming you meet the BMI criteria, but because you gained weight, you don't meet the 2nd criteria.

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From the denial letter it looks like there are two reasons you were denied

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I just got off the phone with my insurance, apparently they are not covering the surgeon appointments (SERIOUSLY) uggh anyway I asked how long it takes once we send in the paperwork for approval, they told be 20 business days.

20 business days - that is another month. All my pre-op stuff (NUT, Cardio and Pulmonary) are finished by September 23rd.

I hope I am able to get this surgery done this year. but a month just for approvals is already putting me at November.

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