Question:
Will Aetna take my word on the diets I have tried?
My surgeons office told me that they don't include my letter when they submit to insurance, but I can send it myself (wierd). I've only been seeing my doc for about 1 year so she doesn't have documentation for everything I've tried. She also said that since she's never treated me for some of the things I complain of, she can't put them in the letter. Well, back and knee pain are not something I run to the docs for!! I dont want to have to dig back and get records from the ortho's I've seen since I've moved around a lot. Do you think my letter will be sufficient for Aetna? Thanks everyone! — emilyfink (posted on April 13, 2002)
April 14, 2002
Hi. I also have AETNA and they were not that easy to deal with in my
situation. I have been approved but it did not come the easy way. Here is
what I did: I wrote a letter to predetermination by following the
guideline letter I found at AMOS, I listed everything that caused me
discomfort, I'm talking everything, I send in with that letter a list of
all the diets that I had ever tried, that included diets from childhood up
to the present time, I included exercise programs and self-directed
programs, I got a letter from my PCP stating my current weight, BMI and
medical issues, my surgeon made me see an array of specialists and all sent
in letters documenting my condition, my surgery was initially denied as
experimental (lap-band) but after re-submitting an RNY request I was
approved within 24 hours!!!!! Read my profile for a more detailed account!
Email me privately if you need help with anything! I go in for surgery on
the 22nd so e me soon if you will need help with anything! Oh, get to a
dietician ASAP--it counts as a dr supervised diet which is very important
in the approval game!
— jenn2002
April 14, 2002
Hi I had AETNA PPO and let me tell you they were a nightmare..I was denied
at first because I didnt have enough documentation..it was only after I
resubmitted and included my own letter that the denial was overturned..be
persistent with aetna call them everyday...TWICE!! Take names and submit
every thing you have ever tried!!GOOD LUCK!
— tylerswife
April 15, 2002
I have Aetna HMO and I was approved in a week and all I had to do was write
the diets I tried, when I tried them, and how much weight I lost then of
course gained back. My surgeon wrote all the problems that I have on the
paper to the insurance co.
— SAMANTHA B.
April 15, 2002
I also have Aetna. I was denied the first time because I did not have any
documentation of weight loss history. Once that was submitted I was
approved.
— blank first name B.
April 15, 2002
I have Aetna USHC MCN(Managed Care). I had to provide all my diet
attempts/failures loses and weight gains. I used approx. dates on
somethings. Luckily I found some old calendars. I also wrote about the
programs I was on(2 medically supervised). This along with the requests on
what kind of exercising and all I've done was submitted. This info. was in
my surgeon's packet and they submitted everything. I was approved for RNY
but FOR ME it was potentially life threatening due to a prior surgery for
acid reflux. I was ultimately approved for a BPD/DS and Aetna paid!!!I
would have as much info. as possible. Looks like you have kept track and
all. I used my weights from my OB for my yearly's. I would include as much
documentation as possible. Then, hopefully you won't need to go back and
give them more! I think as long as you are honest to the best of your
capability and very realistic you have nothing to worry about. I'm sure if
they made phone calls they could verify stuff but I don't think they have
that kind of time.Best wishes to you on this journey!
— Linda M.
April 15, 2002
I have Aenta HMO; The surgen supplied the information on all of the diets
that I tried and it was denied. The reason; "Lack of PCP
evaluation". My PCP wrote a letter, stating the same information and
it was approved a week later.
— Tom Z.
July 12, 2002
This whole process is so frustrating. I am finally getting them to get
around to saying that I don't have enough diet documentation and therefore
they are going to deny my request. I have two phone calls in to my primary
physician's office and no returned calls. This is so frustrating. My BMI
is 56 which should go without a doubt and I have co-morbidities (diabetes
and hypertension). I also have family history of colon cancer and heart
disease. I'll just keep on trying to get it through. Why does it have to
be so hard? Brenda Overall
— Brenda O.
February 28, 2003
Hi. I have Aetna/US Healthcare. I had heard many stories about denials from
insurance companies. I was surprised when I found out that I was approved
my first time around within a weeks time. I supplied the surgeon with my
letter of necessity, my primary care physician's letter of necessity and
they took care of the rest. One thing that might help is if you get in
contact with all of your previous doctors and have them either mail or fax
your medical records to you or your primary care physician. This would
allow your current doctor to at least mention in her letter that she has
viewed your medical records from previous physicians and that your were
treated for certain ailments. In my letter, I mentioned all of my other
doctors, what I was treated for and when. I also mentioned how my obesity
effected my health, work and my way of life. The one thing that I have
often heard people say is that when dealing with the insurance companies,
don't give up.
— LISA F.
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