Question:
What are my chances of approval after appeal b/c of low BMI?
Aetna denied my claim because they said my BMI was too low (it's 38). I have appealed and sent letters that were not sent with my original paperwork. They detail my degenerative disk disease and pregnancy related problems (gestational diabetes, pre-term labor, etc.). Are these considered strong enough for approval this time around? I am just dying to have this surgery and want my answers now! I hate waiting! — Susan C. (posted on April 27, 2002)
April 27, 2002
Hi, I live in Virginia and my doctor is your doctor's partner. I have a
BMI of 38ish, but I am 100 lbs over my ideal weight and my main
co-morbidity is spinal arthritis (degenerative disc and facet joints). I
also have very slightly elevated high blood pressure. I was approved right
away. If they didn't know about the back before, definately appeal because
if they approved me, I can't imagine why they wouldn't approve you. We are
very lucky to live in Virginia when it comes to this surgery!! You can
e-mail me at [email protected].
— cjabates
April 27, 2002
I forgot to say that I have Aetna HMO. Good luck!!!
— cjabates
April 28, 2002
I know allot of women with gestation diabete's but that usually clears up
after giving birth and a proper diet. I my self have BMI over 40 and was
deniged because I did'nt meet medical critera. But unfornatly I don't think
you will be approved because one you didn't send in all the orginal
paperwork. Remember every time you appeal a denial your going to get a
different committee every time. It won't be the same people. Also the
first denial is not from aetna it is from your medical group. Then you
appeal through aetna and they are the finiall stop. I think you can appeal
2 times and then do a independent review after that. If I where you I would
find away to qualify. But don't try to gain weight on purpose to do it. I
suggest you get a lawyer.
— sheri B.
Click Here to Return