Question:
Has anyone been denied by Aetna US Healthcare Managed Choice
I was denied for surgery by Aetna US Healthcare Managed Choice because I did not send them any medical records for doctor supervised diets. I have been on two supervised diets and will send them the information they requested. I was wondering if this has happened to anyone else and they were approved after submitting the medical records for the supervised diets. — blank first name B. (posted on July 23, 2001)
July 23, 2001
I did have to submit history on medically supervised diets. But I think
Aetna is one of the companies that approves this surgery pretty easily.
They just want proof of medical necessity. I gave them my diet history,
weight history, what medically supervised diets I had been on. Then I had
to get a psych exam and then i was approved within in a week. Just get all
your ducks in a row and you should be fine. Good luck!
— [Deactivated Member]
July 25, 2001
It's too bad your surgeon didn't take the responsibilty to make sure his
office squared away your paperwork BEFORE it was submitted. I was approved
in 3 days by the same insurance. Good luck in getting the decision
reversed.
— Julie M.
July 25, 2001
Janet, I read your question with interest when it posted because, like you,
I'm insured by Aetna. I didn't have any "documented" history of
weight loss efforts except for a lifetime membership to Jenny Craig (major
waste of money), but I did supply the names and phone numbers of all of my
previous health professionals, going back to 1984. I can only assume that
they did a little checking and found that the charts even in 1984 indicated
a weight of 225 lbs then, and a steady increase each year. By the way, I
got verbal approval yesterday, with a letter to follow after Aetna
coordinates surgery date with my doc. I'll bet that when you submit the
information to Aetna, they'll approve in no time flat.
— linmazz
July 12, 2002
I received word from my surgeon's office that the letter that I faxed to
Aetna detailing all the diets that I've been on, supervised and otherwise,
was not good enough and that I was going to be denied. I have a BMI of 56,
along with co-morbidities of diabetes and hypertension and a family history
of heart disease and colon cancer. This is pretty disgusting. I've been
trying to get my primary physician to call me back so I can request them to
send something to the insurance and that is frustrating also. But, I'm
going to keep up. I hope it is going to pay off before I die first, which
is how I feel right now.
— Brenda O.
July 12, 2002
Hi Janet, I also have Aetna Managed Choice. I only had 2
"documented" weight loss attempts. The first was Jenny Craig. I
was only there for 1 month. The second time, my OB/GYN prescribed me diet
pills after my 3rd child was born. Again, only for 1 month. Thats it!!
My starting BMI was only 36. Sleep apnea was my only comorbid. I was
approved in less than 24 hours with Aetna. I am now working on a tummy
tuck. Aetna is GREAT!! They are known for their speedy and fairly easy
approvals. Good luck!!
— skymaxjr
October 17, 2002
I am having the same problem. For years I've avoided the doctor, but now,
they want medically supervised diet attempts. I did them all on my own.
My BMI is 56, my comorbids are arthritis, sleep apnea, high blood pressure,
depression and more. I worked for another company and had bcbs and did all
of the requirements for them. I lost my job due to cutbacks and my new
employer is only affiliated with AEtna. The requirements are different and
I'm scared to death I won't get approval. What I want to know is, if my
BMI qualified me for surgery with BCBS, why won't AEtna? I'm still doing
the grunt work for AEtna, and am praying to God I will be approved. Any
words of encouragement or advice are greatly appreciated.
— kathleenv515
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