I have completed everything. During my 3 months of Nut appointments, my weight fluctuated. I lost 3 lbs and I gained 3 lbs. My end weight was the same as my start weight. My net gain was 0. Aetna denied me because I gained weight. Once I lost the 3 lbs, I had to keep it off. In phone conversations they tell me it’s because I fluctuated, the denial letter says I gained weight. They Aetna reps also tell me it’s not a lost cause. These things usually get overturned on appeal.

The peer to peer appeal was denied. The doctor is in the process of filing the second appeal. Aetna tells me I can resubmit my initial claim in October if the appeal is denied.

I have no other appointments scheduled for nut, it seems like maybe I should... just for the weigh in. I am little nervous to call and ask though, because I have lost weight and I am afraid that I will gain a pound back and screw it up again.

I knew Aetna had the one pound rule, but I was under the impression it was a net gain.

Anyone had any experience with anything like this?

Sorry they are making this very hard for you. Ins companies can be very hard to work with. Good luck.

The peer to peer was denied, but I got sick of waiting for the doctor to do the written appeal. So I utilized my option to do my own appeal. Today I found out it worked. I have been approved. Just wanted to update this in case anyone else finds themselves in the same boat.

congratulations!!!!!!

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