Insurance (Aetna)

[nicole242 0]

Yes maybe I should have MYSELF called, but I guess since the office gal told me what I needed to do next, I thought they had already called to find out. I have had the same ins. for 5 years, my son was very ill with a brain tumor and I was very thankful they covered most of the bills. As I have said before this was a HUGE misunderstanding by the suregeons office and myself, With my many other insurance issues I know for a fact that the first thing the doctors office does is call to see what is covered, than has you do whatever is needed to start the process.

[Doublewall 0]

I am a little upset. I was denied today by Aetna too. They said I did not have any co-morbids. even though I have a Psuto Tumor which will only go away if I loose weight. My BMI is around 36.00 but I have to loose weight or I will loose my eye site. I am so mad because I did the 3 month diet and spent my own money to see the Dr. and nutrician Dr. and now they just denied me after only 1 wk. My Dr. said I can fight it but I doubt it will do any good so now I don't know what to do. Man life sucks sometimes.

[silvers320 12]

Doublewall, I don't not IF fighting the denial will help get it approved but I KNOW that not fighting it is certainly not going to get it approved!

I know is frustrating but take some time and work on the appeal. You have nothing too lose and everything to gain.You can get most of the information on the internet. I don't know if your state as a level of appeal but mine did and that's what worked in my case.

Good luck.

[tashanicole1271 0]

Doublewall,

Call Aetna and ask for the link to download their practice on WLS. It was pretty lengthy and I don't remember how to get there. I could almost gaurantee that they denied you because of your BMI. They probably don't consider your psuto tumor a comorbidity. I had to have a 6 month diet and my PCP did it so I didn't have to spend extra for that. I was out of the copay ($20) every month, but that was it for the diet. I did pay to go to the nutritionist and the psychologist, but I only had to see each of them one time. I think your doc could be a little more compassionate in your desire to appeal this. I am very passionate about this and I get upset everytime someone says they were denied! Keep fighting and don't give up! God bless.....

[nicole242 0]

I can not ever fight this because, my employer who writes the plan did not include weight loss surgery. My plan does not for any reason cover this surgery. I am so sad, but have once again started weight watchers loosing 1lb than .02 lbs a week, it is a long slow process, I hope to loose weight and I am trying but, i have 80 lbs to loose. I have borderline diabetes and the insurance company will end up paying a lot more for my treatments, then if the would have assisted me with this weight loss aid. Best of luck to all!!!!