Aetna 1 pound rule

[balancingbilly 2]

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?

[Mountaingal 322]

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

[balancingbilly 2]

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.

[angyplus5 470]

congratulations!!!!!!

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