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AETNA DENIAL

nomorefattypatty

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nomorefattypatty    329

nomorefattypatty
Posted

Ok, so I went through all the months of nutrition classes, blood work, stress test, EKG, and x-rays. I am revising from the sleeve to the bypass because of really bad acid reflux and a hiatal hernia. After Aetna kept giving me trouble I was losing all hope of getting approved. Yes, after all the work I did they said my appeal was DENIED! However, I received a letter in the mail on Friday that ordered Aetna to approve my surgery within 72 hours. Medicare had stepped in and said basically that Aetna is my fiduciary in the medical insurance and they are responsible for keeping me healthy. Due to the fact that bypass is proven to stop reflux Medicare overturned their decision and I am now on my way to getting a surgery date. I am praying that above all other things the bypass is good for that it just relieves my acid reflux and helps me loose another few pounds. I had my sleeve June of 2016 and I'm still doing good. I've gained about 25 lbs. back so I hope it helps me lose and I'm positive it will, but haha to Aetna and don't let these insurance companies dictate what happens with you're health. Stay vigilant and keep pressing forward to your weight loss goals. Thanks for listening.

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Panda333    275

Panda333
Posted

49 minutes ago, nomorefattypatty said:

Ok, so I went through all the months of nutrition classes, blood work, stress test, EKG, and x-rays. I am revising from the sleeve to the bypass because of really bad acid reflux and a hiatal hernia. After Aetna kept giving me trouble I was losing all hope of getting approved. Yes, after all the work I did they said my appeal was DENIED! However, I received a letter in the mail on Friday that ordered Aetna to approve my surgery within 72 hours. Medicare had stepped in and said basically that Aetna is my fiduciary in the medical insurance and they are responsible for keeping me healthy. Due to the fact that bypass is proven to stop reflux Medicare overturned their decision and I am now on my way to getting a surgery date. I am praying that above all other things the bypass is good for that it just relieves my acid reflux and helps me loose another few pounds. I had my sleeve June of 2016 and I'm still doing good. I've gained about 25 lbs. back so I hope it helps me lose and I'm positive it will, but haha to Aetna and don't let these insurance companies dictate what happens with you're health. Stay vigilant and keep pressing forward to your weight loss goals. Thanks for listening.

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Thank you for posting your story. Aetna also denied me after I had been pre-certified, received verification it was covered, completed the entire plan with my surgeon and spent $4500 on pre-op stuff. I was devastated and posted in another thread here. My doctors office actually said, come get your files and find another doctor. The patient advocate actually told me that. I had to summon all the strength I had. I complained to my doctors off, the actual surgeon, aetna, and my employer. it turns out that the person in the doctors office didn't submit my appeal properly and I assume didn't want to get in trouble and thought I would just walk away. Once they appealed I was approved in 24 hours. Good for you for staying positive and I agree, we do not let insurance companies, or even incompetent drs. office staff dictate our own health!!!!

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nomorefattypatty    329

nomorefattypatty
Posted

Thank you for posting your story. Aetna also denied me after I had been pre-certified, received verification it was covered, completed the entire plan with my surgeon and spent $4500 on pre-op stuff. I was devastated and posted in another thread here. My doctors office actually said, come get your files and find another doctor. The patient advocate actually told me that. I had to summon all the strength I had. I complained to my doctors off, the actual surgeon, aetna, and my employer. it turns out that the person in the doctors office didn't submit my appeal properly and I assume didn't want to get in trouble and thought I would just walk away. Once they appealed I was approved in 24 hours. Good for you for staying positive and I agree, we do not let insurance companies, or even incompetent drs. office staff dictate our own health!!!!
I think my doctor's office dropped the ball also. They screwed up the peer to peer conference and said they filed an appeal. Aetna says they weren't available for conference and they never did the peer to peer. They never even returned my phone calls. Finally I got pissed and went in there but it didn't help. I had the sleeve 3 years ago and that dr. was always on top of everything so I assumed that would be the case here. Not even close. I'm glad I kept on top of stuff, but getting approved by Medicare was a Godsend because I definitely prayed for it and that's when I got my approval. Thank you God for your devine intervention [emoji173]

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nomorefattypatty    329

nomorefattypatty
Posted

Finally, my surgery date is October 15th. I have to get a few tests done over because they were due again due to timing but finally my revision is going to get done. I'm praying for no more acid reflux. Keep you posted!

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Frustr8    7,886

Frustr8
Posted

Yeah Please let us know, we want to give YOU a Victory Cheer when it happens, and it's About Time!, at least that's my Point of View!

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Panda333    275

Panda333
Posted

10 hours ago, nomorefattypatty said:

Finally, my surgery date is October 15th. I have to get a few tests done over because they were due again due to timing but finally my revision is going to get done. I'm praying for no more acid reflux. Keep you posted!

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Congrats!! I am October !

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pssk    225

pssk
Posted

I’m your surgery twin on 10/15.

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kathymae    9

kathymae
Posted

I had revision from lapband to RNY.. My insurance approved me and I had the surgery.. I received a bill fo 6700.00 they paid for everything except the actual bypass. Wtf. Finally after 2 appeals and 6 months they paid.

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nomorefattypatty    329

nomorefattypatty
Posted

I had revision from lapband to RNY.. My insurance approved me and I had the surgery.. I received a bill fo 6700.00 they paid for everything except the actual bypass. Wtf. Finally after 2 appeals and 6 months they paid.
Sometimes you just have to give them a fight especially when they deserve it

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