Question:
HELP! Appeal denied by Aetna. Please read!

I just got word that my insurance company denied my appeal. I've been told that the next step is to appeal again...and that the insurance company (Aetna PPO) will send info. to my employer's HR Department for them to sign off on!!! First of all, how humiliating is THAT?!?!? Second, why should my HR Department decide my fate? I work for a large company and I'm just a number to the HR Department. They don't know me at all! Has anyone had this same experience? Please help! I need suggestions... THANKS!    — pamela1 (posted on November 8, 2002)

November 8, 2002
I'm curious as to why you were denied, AETNA is typically pretty good about approvals. Could it be your employer has an exclusion policy against WLS? I had AETNA and had very few problems after the proper documents were provided. check out my profile for AETNA info. Good luck.
   — jenn2002

November 8, 2002
Your employer sets the benefits and is in total of any coverage decision when you are covered by a self-insured employer that is typically how PPO's are funded. Therefore it is not Aetna, but your employer's call whatthey will cover and that is why the HR department will be involved. I had Aetna HMO andhad no problems being approved. Did they say why they would not cover the surgery? My hubby helped me answer your question as he used to work for Aetna. I wish you the best of luck with any appeal.
   — Molly S.

November 9, 2002
I am sorry to hear about your denial. Keep trying. I can only tell you I also have Aetna PPO and I was approved in 3 weeks. The nurse in the surgeons office said Aetna is really good about approvals and that held true in my case. Good Luck. k.
   — Kay S.

November 9, 2002
I have aetna and was approved in 17 days. The key is the letter of medical necessity sent by your pcp. Make sure they list all diets, weights gained and lost and any health issue you have. Be very specific for the last 2 years. Don't give up.
   — Tawnda C.

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