Aetna help

Hello all, This is my first post here. I am hoping that someone can give me some advice. I just recieved my 1st denial letter from Aetna. They say that I need to have a BMI over 40 for 5 years. I was only a 37.5 in July of 2005 so I am denied. I am at 41 now with high chlesterol, sleep apnea, constant knee pain, and an extensive history of heart disease. I plan to appeal. Any idea what my chances are of being approved? I am crushed by this denial as my surgery was set for the day after my birthday in March and I was so ready for it. Thanks, Mike

Welcome Mike! With aetna you have to fight, they always seem to try some excuse and want you to give up. So hurry with the appeal, i'm sure you'll get approved especially since you have sleep apnea. Hugs Linda

One typo....I have an extensive "family" history of heart disease. No problems with my own heart yet. Mike

I don't know about Aetna but i do know that carrying a BMI of over 40 for five years is VERY DANGEROUS to your health. Aetna should be disgraced by this!!! It's like they're telling you to go out there and risk heart disease, stroke, arthritis, liver disease, and any number of other health hazards before they're willing to approve something that will do much to help you prevent those types of problems! I'll bet you didn't know this but my surgery wound up costing the insurance companies less than an MRI! (i guess the surgeon and hospital took a beating on what the insurance company was willing to pay, but they still did the surgery). Why they would deny it is beyond me. It's seems so cost effective for them to just approve it. I think you should keep fighting. I had to fight for three years to get my surgery and now i've lost 200lbs and my health is better than it's been in decades. Don't give up! Good luck to you Mike. -jay

Mike, Aetna denies most people at first.. read my profile and you'll see what a PITA Aetna can be. Now having said that there are a few of us on here who SUCCESSFULLY appealed Aetna.. myself included. Send me an email and i will GLADLY share my appeal with you! ~Erin PS: on a bright note, Aetna must be so sick of me they approved my Tummy Tuck with in 2 weeks of asking! BE POSITIVE!!!!

Hi Mike... Have you checked with the coordinator of the group/ surgeon you are working with to see what they submitted? It could be just a matter of words or documentation. I was told right up front when I called about the pre-cert that if there was any missing information it would be an automatic denial and I would have to appeal. I have Aetna myself I cant say that in the past I have been too impressed...however to my suprise I had no problems with getting approved. I feel I owe the success of this approval to the bariatric coordinator that I worked with. Its all about wording with them it really is!

Hello all! First of all, I wanted to thank everyone who got in touch with me the past 24 hours. Your stories, ideas, and overall well wishes were fantastic. I just wanted to share with you all what I have found out today. I verified with the MWLC that they did not send in my Sleep Apnea information. Evidently, the results were not in my file on the date they submitted me for approval. The next problem is that they didn't ask me for records from my PCP from 5 years ago. They requested this from me today for the appeal. I sure freaked out b/c I new I wasn't this big 5 years ago. To my relief, if you can call it that, I weighed 246 lbs then, which put my BMI at 35.3 then. So, with my 5 year history of BMI over 35 and my Obstructive Sleep Apnea with CPAP treatment, I should win my appeal against Aetna. I sure hope this Appeal doesn't take long. I am mentally and physically ready right now. I'd love to get this going and enjoy more energetic summer with my wife and son. I'll keep you all up to date with my progress. Thanks again, Mike

Well, Aetna denied my appeal. I lost some weight (80 lbs) in 2005 but gained it all back in 2006 plus some (90 lbs). They said that I didn't show a 5 year history of severe obesity. I am so mad now. I sent them documents from my PCP showing my BMI at the following: June 2002 35.0 June 2003 35.1 January 2005 38.6 July 2005 40.5 January 2006 (strict 6 month diet plan) 28.4 January 2007 41.5 I also have obstructive sleep apnea. The people at MMPC and the nurse at Aetna cannot understand why I keep getting denied. I am filing an "Appeal 2" on Monday. If that get's denied, I guess I have to start legal action.