Please send me the attorneys number, I had it once back in 2008 when I had to have a revision. He was great, I now have a friend that needs her gastric band removed but insurance won't pay for it. I want to provide her with the attorney so she can go forward.

They said they will not accept any new information, I did go in again this month on the 31st which would technically give me about 120 days but she said my only option is to do an appeal at this point.

I am not sure, I think the lady at the doctors office wasn't really trying to do her job.  She just called me back and said she talked to Aetna and they said it was denied because I did 88 days and not 90 and that now I have to send in an appeal letter.  She said they have never seen them be this strict before and that this has never happened.  So now I need an appeal letter example and need to know how to get Aetna to expedite it.

Thanks for the info.  The 90 days would have been up by the time my surgery was suppose to be in December, they are actually asking for a 3 yr weight history which is now moot because I had a weight taken this year which gives me 3 years of weight history now.  The issue now seems to be that they are saying that my plan does not cover me doing a 90 day program which makes no sense because that is not what they told me when I called before and during the process.  Aetna is telking me the only thing I can do is have the doctor do a peer to peer or do an appeal.

Unfortunately, Aetna is that strict (at least regarding the 3-month/90 day diet).  It really needs to be at least 90 days (I did mine for 100 just to make sure).  I am not sure what you mean by your plan not covering a 90-day program - mine didn't either, so I paid out of pocket for one - it was worth it to me.

If you don't have the 2-year weight history, there is not much that can be done right now, at least as far as appealing Aetna.  That is their requirement, and they are entitled to set their requirements.  This requirement is pretty common for most insurance companies, so it is not outrageous, egregious, or arbitrary.  How close are you to meeting the requirement?

As for the 90-day plan, keep going - don't stop.  If not more than a month has passed since you last saw a doctor for the diet/program, you should be able to keep going and have it count towards the 90 days.  One more visit ought to do it, and then you can resubmit.  At least as far as the 90-day program goes.  This won't help your weight history, see above.

It really sounds like you need to get your hernia repaired, and then worry about qualifying for WLS.  I'm not sure that Aetna will see the two as being related.

Good luck.