Question:
DENIED
HAS ANY ONE BEEN DENIED WITH AETNA CHOICE POSII OF LA.WITH EXCLUSION POLICY — msjackiej (posted on July 10, 2007)
July 10, 2007
so many people are complaning about the same thing.my ant has been denied 3
times. a little secret . constantly go to a dr, or nutrition for weitloss.
the moore you go the better your chance is for aproval, if your unable to
loose the weight on your onw. if you have proof such as a gym member ship,
going to a dr, for weightloss, any weightloss program in the past submitt
it and apeal it again. dont give up ok. get as many refearl from your dr,
stating that this is medical nescary for you.
— yvettetas
July 10, 2007
the ONLY solution is www.obesitylaw.com Walter and Kelly are absolutely
the best advocates for ins approvals anywhere! I had been denied by aetna,
appealed and denied and then I hired them to advocate for me....APPROVED!!!
I started in Oct 06 and it is now 7/11/07...they approved me on June 29th
but STILL have NOT sent the approval letter out! They plain suck!
— LouAB
July 11, 2007
I have Aetna Choice POS II als and have been getting denied for a year and
finally I got a call last friday that I am approved but waiting to get
approval letter also, whatever you do don't give up and be persistant and
amke sure you have all your "ducks in a row because they aren't going
to give in easily. Good Luck
— BETCBOO2
July 11, 2007
Sorry to be the party pooper here but if your policy has an EXCLUSION rider
for weight loss surgery...then it is just that- EXCLUDED. You can fight it
until you are blue in the face, but the reality is, an exclusion rider
means coverage is excluded for a particular condition. It has nothing to do
with medical necessity. I would say start saving your money or find another
insurance company that covers the surgery. Good Luck
— AmyinMA
July 12, 2007
Rather than waste another year of your life waiting for someone else to
make the decision for you. Be come pro-active rather than re-active. Find
out IF they EVER do approve you, what portion will they cover. Very few
will ever cover more than 50% Which will still leave you with on the
average of 12-15,000 being your out of pocket expense. Rather than fight a
battle I would probably never win, I decided to see what other options I
had with MY OUT OF POCKET EXPENSES. After all, If I was going to have to
come up with this amout of $ I wanted a little more control, than them
telling me how when where and what to do, and then just hand them a check
for $15,000. (My half) Well the trend in insurance coverage is swinging to
companies paying their employees cash to go have major medical proceedures
out of the US. As the cost is a fraction of what it is going to cost them
in medical expenses little alone the insurance premiums. If you can get a
proceedure done out of the US for $10,000 including travel and everything
that would cost upwards of $100,000. here in the states, financially it
makes sense. So I did my own research and found more qualified surgeons out
of the US and the cost was less than "My out of pocket expense here
inthe states. Yes there were questions and concerns, but I did my homework
and was more than 100% at peace with the decisions that I made in going to
south San Diego (ie. Tiajuana) I had surgery 2-2-07, the medical facility
was incredible. A brand new gorgeous hospital. Cleaner than any I have
been to here in the states they were extremely attentive, New modern
equipment (my brother is a maintence foreman in a hospital,and he was
amazed at the quality of the equipment that they had at their disposal.
Plus I got a quality surgeon who has been doing lap bands for over 6 yrs
longer than they have been approved for here in the states. He does on the
average of 4-6/day. and that is all that he does. Oh and by the way, he
trains the US surgeons on how to do the lap-band proceedure. Whow would you
want ....the masster or the student????Since my first fill on 3-15-07 I
have lost a total of 105 lbs. That is 4 months that I could have spent
getting upset and crying and hating life because i was DENIED again!!!!
Remember insurance companies are in it for the profit, not for our personal
well being. I am so grateful that I looked outside the box, or I would have
still been traped in that box. I love life now, and cant wait to lose the
other 100. Don't let someone else determine your destiny and happyness.
Best of luck and if you have any questions or comments, please let me know.
Also, all of my fills are free for life. all i have to do is get to mexico.
guess what, it is cheaper to get a plane ticket, take a taxi to and from
the border, to and from the hospital and back home again than it is for me
to have a fill here at the "world class hospital that I have less than
1/2 mile from my door. Guess where I go. Viva Baja California!!!!!!!
— mccabesmom
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