Question:
What do I do next, I was denied?
My worst nighmare came true today..DENIED!!! Not enough medically supervised diets...where do I go from here?? — tylerswife (posted on October 16, 2001)
October 16, 2001
Rebecca, I know how you feel, I was denied by aetna yesterday. My surgery
was scheduled on Oct 30 and the doctor office told me last week that there
wouldn't be any problem with the ins. Well I received the call and she
really didn't seen to care like it was okay with her. I was so angry!! I
faxd an appeal first thing in the morning hopefully I will hear soon.Good
luck with your appeal and don't give up!!! I am going to drive aetna crazy
until they approve me and you should too!!! LOL Bonnie
— Bonnie S.
October 16, 2001
Start a medically supervised diet (find out what they want, just a diet or
diet and medications combined..).. just in case the immediate appeal falls
through you know you'll have it for next time you file.. But you may want
to try asking your PCP to write a letter for you concerning your
co-morbids, and put some urgency in it. In reading your profile at 410 lbs
I would even have him go to the extent of having him say it's life or
death. I weigh 500 + so in no way am I trying to be offensive here, I've
been here done this so speaking from experience (literally denied for the
same thing the first time)... Unless there's a clause in your plan that
calls for an exclusion, it may work, it may not, but it couldn't hurt, I
actually typed the letter for my doctor to have printed on his letter head
and sign for my insurance.. If you'd like a copy of it feel free to email
and ask... It worked for me, but I have a different insurance so no
promises.. I would also make a list for my doctor to send with this letter,
a list of all the non medical diets you've tried, and I have a copy of one
of those too with the time frame, diet, outcome ect listed.. Good luck
— Elizabeth D.
October 16, 2001
I also would get other things pertaining to weight loss, not just Dr.
documentation. Have any weight watchers stuff and the like around the
house? ie: receipts, books, etc. Proof of a gym membership in the past.
Letter from family member(s)Chiroprators visits.Sometimes the lil things
add up. They did for a friend of mine. Good Luck.. Don't give up!!
— Marie A.
October 16, 2001
The same thing happened to me, but my denial was overturned on appeal.
Find out what was the basis of their denial, in writing. If they refer to
their plan documents the parts referring to treatment of morbid obesity,
request a copy of them. You may pay a small fee for photocopying them.
These will tell you what the criteria are for being approved; they don't
want to tell you, but you have the right to know. Then I wrote a 6 page
typed letter, and got my surgeon to write one also. There are details of
my journey on my webpage, as well as under "other sites to get
info" I list places to get info on how to fight denials.
I know you feel like you have just been kicked when you are down, but I got
my denial overturned, despite being told that there was "zero
chance" this would happen, so don't give up. My webpage is:
http://www.lkdobson.homestead.com
and I wish you all the best of luck. Fight back. Be polite, but remain
persistent.
— Lisa D.
October 17, 2001
Obviously you need to find out precisely what they need in order for you to
get approval. For example, Blue Cross/Blue Shield of ND required that I be
on a medically supervised diet for 3 or 4 months during the past 12 months.
I IMMEDIATELY went to my personal physician and began one. When I
finished that, I was approved in one week. WE DO HAVE TO FOLLOW the terms
of our insurance. So, find out what they want and then do it -- then seek
approval afterwards. I know the waiting is bad, but it will pass.
— Cindy H.
October 17, 2001
— Benita W.
October 17, 2001
These insurances are so weird!!! I have Aetna HMO in Houston, TX. I was
told 2 med. supervised diets 12 weeks or more each. BMI 40 or 35 w/
comorbids. I have been on Fen-Phen, Meridia, and Redux w/ my PCP over the
past 3 years. So I feel I shouldn't have a problem, but now I'm starting
to worry.....
— Cindee A.
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