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Aetna ***

Luckysgirl1909

By Luckysgirl1909, in Insurance & Financing

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dede0314    356

dede0314
Posted

I was denied from weight gain and my denial letter only had one reason... The other seems like either the BMI criteria wasn't met or the doctor didn't send any records that she has been overweight for a period of time

But I would call the insurance company to clear it up...

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aslcertified    86

aslcertified
Posted

Lindstrom is working on that for me but it's just the waiting part giving me anxiety and wanting to know how much fighting with them they can do.

They think it's bananas , so hoping that they can get this cleared up by November if not I'm going to change insurance during open season and start over.

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aslcertified    86

aslcertified
Posted

@@ZollDoll wow! 20 days!! That's too long to wait , that would drive me up the wall.

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Cross fingers you are approved but sounds like you are on track and all is in order.

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aslcertified    86

aslcertified
Posted

wow! your situation sound similar to mine but I was not offered an additional 3 to 6 months it was just a Denial, AETNA seems to not know anything, its either this or that and you follow through with what they want and you are still DENIED. so I had hired advocates to fight this case since Jan and was still denied July 27 so last week my advocate decided to go another route and do a resubmission for precertification to see if they would review again to deny or approve which of course will take 7 to 10 business days. so, just an hour ago out of the blue, I received a call from Aetna who says she was assigned to me as my case manager and the reason for the call is to do a health assessment before my surgery date AUG 29th . I was thinking to myself " im confused" ," what the heck is going on" but ok ill just go with the flow and talk I did not want to sound confused to jeopardize anything my advocate has been working on so she asked general questions about 3 month nutrition, after surgery plans , my weight etc.... then she says I am happy that you are wanting to make a lifestyle change and I will be calling you on AUG 31st to follow up after your surgery if you may need other assistance. I am still thinking ok is this standard procedure before they decide to approve or deny or if this is an actual approval ???????? :huh: I did not want to ask the case manager because as I said before , I was just going with the flow and did not want to jeopardize anything my advocate had going.

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SoCalGal77    7

SoCalGal77
Posted

i have read on numerous sites and insurance sites and i mean i have researched like a crazy person,- it is to my understanding that 75% of people that apply get denied by their insurance companies and you have to appeal it. This is including statistics from all major insurance carriers combined. Another 50% of applicants are denied 3 or more times and kept appealing until they won. So you may be in it for the long haul. Just stay focused and don't let this news get you down, at least you can re submit. Some people even try to gain purposely to meet the requirements, thats how hard insurance can be to approve this surgery.

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bevmccarthy    26

bevmccarthy
Posted

I have Aetna. Live in Florida. I'm waiting for the insurance to get back to the dr I'm stressing. I have a high BMI sleep apnea high blood pressure diabetes. Shouldn't that be enough?

I have a tentative date of 10-21-16. Hoping that insurance will come thru.

Bev

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aslcertified    86

aslcertified
Posted

@@bevmccarthy did you gain any weight on your last weigh in ??? FYI Aetna is strict on any weight gain So if you did not gain weight on your last weigh in then you are good to go.

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gina171    626

gina171
Posted

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

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

Looks like the only problem is with a NET gain, so there's a little forgiveness there.

But seriously, those requirements are exceedingly tough. I don't think they are fair, to have a BMI between 40 and 49 and REQUIRING a significant comorbidity as well? Ridiculous.

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Go To Topic Listing Insurance & Financing

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