Question:
There is no exclusions in my insurance policy, How can Aetna PPO deny me?

exclusion in my companies policy for wls surgery...so how can AETNA PPO deny me? I have provided them with everything that they requested!!    — tylerswife (posted on November 4, 2001)

November 4, 2001
I had the same problem with Aetna...appeal the denial. I think they deny everyone the first time. I then had to get in touch with their district manager and have her work it out because everyone at their customer service number keeps telling me something different. Document EVERY conversation. Feel free to write me if you have questions.
   — sandieguy

November 4, 2001
Rebecca, I am very sorry this has happened to you. First you must find out why they denied your request. If your submittal was deficient in some way, perhaps it can be corrected and resubmitted. I also have Aetna PPO. Unfortunately, my employer is self insured and although Aetna has no exclusion for WLS, my employer does so I must pay for my surgery myself. I will pray that you can resubmit and win your fight. God Bless you.
   — [Anonymous]

November 4, 2001
I have to disagree with Sandie...Aetna does not turn everyone down the first time. I had a starting BMI of only 35 with sleep apnea being my only comorbid. I was approved within 24 hours. I would definately appeal!!! Dont give up!!
   — skymaxjr

November 5, 2001
You need to find out the exact reason for the denial and then address that issue. I was approved by Aetna the first time in about three weeks. It may be a matter of some little detail being overlooked.
   — Gina E.

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