Question:
Getting Aetna insurance approval Help !!!
I'm going to keep this short and sweet. I was approved by Aetna for surgery in January. I didn't go through with it, and would like to have it now. I have to have surgery in August, but I was denied for it due to "lack of six month diet, within the past 2 years." which is complete crap. Most people I know don't make a habit of going to the doctor to get weighed every month. The next time I would be able to have surgery would be in late December or early January due to my work and school schedule. According to the surgeons secretary, everything with aetna has to be completed 30 days within the approval date, 60 at the most. I don't know if this is true. I have e-mailed the surgeon to ask if I could have his support on an appeal, he has yet to get back to me. I don't want to do business with them over the phone, the secretaries either rush me off the phone, or have an accent so thick I can't understand them. How do I get this approved? When should I do it? How do I coordinate all this? I am getting very frustrated with this, and am wondering if it's even worth all the aggrevation. P.S. The insurance company specifically states that a written diet history is unacceptable documentation. I may look into yet another surgeon if this guy doesn't get back to me soon. — Matt K. (posted on July 31, 2003)
July 31, 2003
Hi. I have AETNA and was approved, but had doctor documentation of diet
plan failure, weight increase and Phen Fen. AETNA, at least my plan, when
they approve have a time limit.
I am thinking mine was 90 days. You need to find a Primary Care Physician
who will provide a letter stating your weight loss attempts. Mine was
wonderful. Why in the world didn't you have it in January?
— cutebrunette 1.
July 31, 2003
I also am going through the same thing just about with Aetna ppo. I didnt
know I had to be weighed in every month when my pcp put me on a 1200 cal
diet..I started in may then few weeks later decided to research wls and go
forth with it..with all the chart notes they say what they want and what it
has to say in there is ridiculous(SP?), now their telling me I have to have
a 6mo diet with dietian consult..i cant believe some of thier
policies..well i'm going through it all what they want no matter how long
it takes.. making sure my pcp puts everything in it just to throw in their
face...I want this so bad! good luck on your journey!
— por2geegurl
August 1, 2003
Hi! I also have Aetna and they are very finicky when it comes to approval.
I tried to get surgery in 2001 but was denied. I appealed it myself and
was approved. I ended up not having surgery until July 2003 and had to
reapply and was approved. I think the bottom line w/Aetna is that you need
to appeal this yourself. I did not go through the doc office w/my appeal.
I sent in about 25 pages worth of Weight Watchers documentation, copies of
Sleep Apnea tests, any receipts from any diet I have ever been on, and
basically anything else I could find. I got an approval from them after
that. A gal I know was denied this year and she also sent in her own
appeal and was approved. I think they want to see how much you are willing
to fight it. Good luck!
— Sasha A.
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