Question:
Does anyone know what

I received my denial letters in the mail yesterday. I am covered under my husband's insurance which is Aetna PPO. All it says is: "The following has been requested: unlisted laproscopy procedure; unlisted laparoscopy procedure, intestine." This service has been denied for the following reason: this is not a covered benefit under the terms of the plan." Does anyone know what this means, or had any experience with this before? We've looked at the policy up and down, front and back. There is nothing in there stating that these types of procedures are excluded, and there isn't anything stating that any type of WLS is excluded either. Also, given the nature of the denial. Does anyone have any suggestions on how I should write my appeal letter? Thanks so much to everyone! -Autumn    — autumn F. (posted on November 17, 2002)

November 17, 2002
Hi Autumn - Have you talked to your surgeons office about this? It sounds like the insurance co. can be "stalling" since they state that the surgery is "unspecified". Sometimes having your Dr's office resubmit is the key. I would talk to the insurance person at your surgeon's office first and see what they are willing to do for you. They are usually very helpful.
   — Renee D.

November 17, 2002
Autumn, the other poster is right. Talk to Sherrie at Dr. Rizk's office. They are not going to give up easily on this. Just wanted you to know I am still here for you. Take care.
   — tulagirl

November 17, 2002
Hey if i were i would get my surgeon to re-submit you request quickly because Aetna is rewritting their policy for Bariatric surgery ?????
   — Barry Q.

November 17, 2002
Call your insurance company. There are some who won't pay for laproscopic, but will pay for open surgery. That could be the issue.
   — joeandteri

November 17, 2002
I'M HAVING THE SAME PROBLEM WITH AETNA. I WANT THE LAPBAND SURGERY. IF YOU GO TO WWW.AETNA.COM. SEARCH: WEIGHT LOSS. YOU WILL SEE THE SECTION WHICH TELL YOU WHICH SURGERY THEY WILL APPROVE AND WHICH THEY WON'T.BASICALLY, THEY'LL APPROVE THE RNY AND THE VGB, IF YOU MEET A CERTAIN CRITERIA. I.E. BMI OF 40, IF YOU ARE BELOW THIS YOU HAVE TO HAVE A CERTAIN AMOUNT OF MEDICAL PROBLEMS, HIGH BLOOD PRESSURE, SLEEP APNEA,ETC... (I BELIEVE 3 MEDICAL PROBLEMS ARE REQUIRED). I HOPE THIS HELP. DONNA
   — donna C.

November 17, 2002
It sounds like they may not pay for the TYPE of surgery you requested. Some insurance companies will only pay for RNY, for example. Were you trying to get approval for a lap band or something other than an RNY? Talk to your insurance co., find out which bariatric procedures they cover. Also, talk to your surgeon, make sure the letter was clear as to which procedure you wanted performed. Good luck.
   — Tamara K.

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