Aetna Help please

Hello I just found this board and would like to listen any advice or help.  I started this journey in August.  My doctor explained to me that Aetna has their own set of rules that I would have to follow.  First I would need to attend his 3 month multidisciplinary lifestyle program in lieu of the 6 month diet.  He informed that he was having no trouble with Aetna in this course.  Of course this would be an extra cost not covered by insurance. I started this program in September and completed 12 weeks at the end of November.  Everything was well documented.  I religiously filled out the food diary, had every test and  am wearing my CPAP each and every night.  Middle of December I was denied because 3 years ago my BMI fell below 35 after once again dieting.  In August my BMI was 41.  An appeal was started and today over the phone once again Aetna is turning me down.  I don't know what to do.  Two events in my life are coming up that I had hoped this would all be completed 1- a trip to Cozumel with friends that was scheduled for May because of my surgery & my step son's Jamaica wedding later this summer.  My doctor can not start the second level appeal until they receive official notiice.  I don't know what can be done.  Please any info would help Pat

Pat,   How distressing!  Oh how I hate that you have to go thru that....I am afraid something like that may happen to me too, because my BMI is around 36, and I'm just starting my 6 mo. dr diet. I know you wanted this behind you especially for your sons wedding. Let me know how it eventually goes for you, and if you finally got them to pay  I hope you can get some help from the expert posters here on OH. Best regards, Vicki

I am in a similar situation with Aetna. I was denied because my BMI did not exceed 40 persistently over the last 5 years because I lost weight from doctor recommended diets, exercise and weightloss medication perscribed by my doctor. I was also turned down because they do not feel my sleep apnea is severe enough. I was given the run around since Nov 1 because Aetna told my surgeon's office that I needed to do a pier to pier review before I could do a first level appeal. On Jan 2nd I got the word that I had to appeal, but I have been trying to get my corporate office to help as Aetna is wrong for the behavior and should be held accountable. I think I am going to use a lawyer to file my appeal. -Nicole

Nicole; I am afraid that the lawyer route is what we both might need to do.  I do have a person through my husbands employer who is looking into it for me.  Will keep you posted if anything comes of it.  Let me know how you do.  I keep asking why does Aetna have to make this so hard?  There are so many steps to this process that all they are doing is hindering  our well being.  Good Luck Pat

Pat, I also have aetna. I had 2 denials and I hired Gary Visco. It was along process. But everything worked out and I had my surgery 12/14/2006, and I am down 47lbs. I did find something out in the end that I wish I had done sooner. Call the human recourse manager at whom ever holds your insurance. They were alot of help to me. They sent off for a external appeal and I won. My BMI was the same. You just have to keep on them. I started my journey November 05, if they would have approved it at the first part of the year I would have had to pay $5000.00, but since they jacked around I only had to pay $900.00. If you need help I will be glad to answer any questions you have. You can email me at [email protected]. Good luck Lynnette