Help! I am just getting started. I have Aetna Insurance and live in upstate NY. I have been told by the surgeons office I wish to use that Aetna never approves the lap band surgery. My BMI is under 40 (38) and therefore they want me to have some comorbidities. If Anyone can help please.

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.

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.

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.....

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!!!!