Aetna denial

[JaysWife 22]

For the second time now I've been denied by Aetna. Their reasoning is lack of information. I started my whole journey at the of July/beginning of Aug. 2020. I did the required 12 classes as fast as they could send them to me, which at the time was acceptable. Had all the testing and everything done by end of Sept or there abouts. My hospitals insurance team got everything together and sent it to insurance and they denied it stating the didn't receive 6 months of dr supervised classes nor 24 months of documented obesity. So my Dr tacked on 4 months of classes one class a month and the nn said they would go to my previous provider for the weight history. Fast forward to now, I have completed everything and have a tentative surgery date of March 22nd. Tomorrow is to be my pre-op appointment but I found out today that my insurance denied it AGAIN. Saying the exact same reasons are the cause. I'm devasted. I've been working so hard. I've been hungry for days. Fighting off the emotional eating and sweets that I crave so badly for something that I feel like will never happen. I can't afford to self pay. I feel like this is the end for me.

[GreenTealael 24,864]

44 minutes ago, JaysWife said:

For the second time now I've been denied by Aetna. Their reasoning is lack of information. I started my whole journey at the of July/beginning of Aug. 2020. I did the required 12 classes as fast as they could send them to me, which at the time was acceptable. Had all the testing and everything done by end of Sept or there abouts. My hospitals insurance team got everything together and sent it to insurance and they denied it stating the didn't receive 6 months of dr supervised classes nor 24 months of documented obesity. So my Dr tacked on 4 months of classes one class a month and the nn said they would go to my previous provider for the weight history. Fast forward to now, I have completed everything and have a tentative surgery date of March 22nd. Tomorrow is to be my pre-op appointment but I found out today that my insurance denied it AGAIN. Saying the exact same reasons are the cause. I'm devasted. I've been working so hard. I've been hungry for days. Fighting off the emotional eating and sweets that I crave so badly for something that I feel like will never happen. I can't afford to self pay. I feel like this is the end for me.

Request an appeal and have your team resubmit everything over again. Also ask if they will provide you with copies of everything that will be submitted so if there are any mistakes you can catch them yourself.

Good Luck ❤️

[Walter Lindstrom 42]

I’m sorry to hear about your issues. I hope you have not yet exhausted your appeal rights. I urge you to call us for an assessment of how we are able to help. 25 years of advocacy and thousands of appeals later, we know what we are doing 👍🏻 Ask around the BariatricPal site.

[JaysWife 22]

32 minutes ago, Walter Lindstrom said:

I’m sorry to hear about your issues. I hope you have not yet exhausted your appeal rights. I urge you to call us for an assessment of how we are able to help. 25 years of advocacy and thousands of appeals later, we know what we are doing 👍🏻 Ask around the BariatricPal site.

What is the number? I will call right now!!

[Walter Lindstrom 42]

My bad! I probably need to change my signature because I thought it was there automatically. Thanks for letting me know. The telephone number is 1-877-992-7732. You will speak with Kelley, my better half, partner and wife of nearly 39 years. She’s talking to someone now so leave a VM message if she can’t answer and she will call you ASAP. Thanks!
Walter

[JKALLDAY 0]

How have things gone for you? Were you able to get the surgery?

I am curious and hopeful for you, but also selfishly want to know because I also have aetna insurance.

Thanks

Sent from my Pixel 4a using BariatricPal mobile app

[JaysWife 22]

I am still fighting with them. They have "misplaced" or "not received" the documents they need 3 times now. They FINALLY have them scanned into their system as of 3/10 but I was told it can take them another 30 days to process them. And that's just for the predetermination. I still have to go through the pre-certification process yet. My surgery has been pushed out 3 times now. I have a new tentative date of 4/7 but I'm not holding my breath for that to be the actual surgery date. It's been a nightmare in all honesty. The back and forth between insurance and the surgeons office, the uncertainty of whether I'm actually going to be approved or not, and the rescheduling of things over and over again. There have been many times through it all where I have very seriously thought about just saying eff it all and giving up. But I know this is kind of like my last hope so I keep at it. I call the insurance company every other day to try to get updates even though it's always the same thing. I was finally told that I should have an answer by this Wednesday so fingers crossed I do and it's a good one. My recommendation is to stay on the insurance company, keep records of who you speak to and when, and just be prepared for possible scheduling changes. I truly hope my case is just a fluke and that others don't have to go through all of this!!

[mamabear_2_2 39]

JaysWife - how did things turn out for you? I hope you were able to get your approval!

[JaysWife 22]

On 5/26/2021 at 1:21 PM, mamabear_2_2 said:

JaysWife - how did things turn out for you? I hope you were able to get your approval!

I FINALLY am able to get my surgery. I'm scheduled for June 30. I had to drop Aetna to be able to get it tho. It was such a mess! But either way I am just thrilled to finally be able to get it done!!