Question:
How many denials before Aetna approve
Hellow everyone, I just recieved my second denial letter last week, from Aetna I have completed a 6 month program through Neweigh in houston and they still are saying no. ...please help !!! — domino1123 (posted on August 17, 2006)
August 17, 2006
I really feel for you. I have AETNA and they denied me at first. I was
hysterical, felt like this surgery was my last hope and it has been taken
away from me. What helped me was I spoke to the HR person at my husbands
work (he is my primary insurance) and she called her rep at Aetna and then
it was reversed!! SO CALL YOUR HR PERSON AND HAVE THEM HELP YOU. Please
email me if you have any questions, I know how lost you are feeling now.
By the way, Im 5 months post op now!!
— jomamma
August 17, 2006
I have Aetna and was approved first time. What reasons are they giving for
your denials? Do you have a written copy of everything they are
requesting? I did blood work, EKG, psych eval, 6 month supervised diet
(must be continuous, every month, must weigh every time, PCP must document
your progress and what you talk about), physical check up with nurse
practictioner, lung x-ray...I think that's it...sorry, can't remember.
Your surgeons office should be helping you with this. I did nothing - my
doc's office handled everything. I'm sorry you're going this - don't give
up! Ask your surgeon's office for help. Good luck!
— platypus
August 17, 2006
My GP called the medical director for Aetna for my area and had it out with
him. After a 30 minute phone conversation, I was approved. Unfortuately,
not all GP's will do that for a patient. I was told by my insurance broker
that each year as the new plans come out they are making it harder and
harder to get approval.
— WMKaisla
August 18, 2006
I also have Aetna PPO. id you get their clinical guidelines for gastric
bypass and follow them exactly? You need a ltter from your physician with
documented weigh-ins every month for six moths. You need to see a
nutritionist. You also need to have your comorbidities documented. (sleep
apnea, high blood pressure, diabetes, etc). Then you need a psychological
evaluation. I also had blood work and a letter from my surgeon, as wwell
as my own letter detailing the problems , physical and psychological, that
I underwent from my obesity.
Finally, does your BMI meet eh level required?
If you have all that, I don't know what to tell you except to keep trying.
If you don't, then get it.
— Novashannon
August 20, 2006
I am 2weeks out.I had my WLS aug 10,2006. Dr Kodali is my Dr. and I also
go to Neweigh. I also have Aetna but I have the (HMO) version. I too was
denied 2 times, Neweigh has everyting under control, just sit back and
relax they will fight this thing for you.They will handel Aetna for you,
just be encouraged,get your bag packed, and start your after surgery
shopong for all your vitiams, protien shakes. Good luck see you on the
other side!!!!!keep your head up, dont give up dont give in.Get ready, get
ready, get ready.
— newbegining
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