Did you ever get an answer? Who is your employer?

Hi Paige,

I will be glad to help and send you copies of my appeal letters however it looks as if you have not meeting their criteria of being morbidly obese for at least two years as defined in their clinical bulletin 0157.  If you go to Aetna's website and in the search box, type in 0157 andit will bring up their clinical bulletin for the requirments to qualify for WLS.

The requirement for proving you have had at least a two  year history of being morbedly obese states that your BMI must be >40 for at least two years or >35 with 2 co-morbidies.  Since your BMI was 35 and 37 in those years you will need to have documented co-morbidies. 

Nan

Hey Ms Nan. Dont know if you are on this site anymore. I sure do hope so. Im doing some research cause I received that call from my surgeons office that Aetna denied me for VGS. SO, I goodled appeal letters and came across this website and this forum. I saw where you helped someone w/ their letter to Aetna in an attempt to have my denied surgery, approved. I havent yet received my "offical" letter from Aetna yet, but when the surgeons ofice called me w/ the bad news, she told me it was due to my weight history. One time in 2010 my bmi was like 35.? and another time in 2010 it was 37.? And then they brought 2009 in the picture. Im like WTH. SO, I see that you have some experience on writing quite a few appeal letters, may I have your expertise on mine? I would sooo much appreciate it.
Hope all is well w/ you.
Thank you soo much!
Paige

Hi Nikimona,

I'm a new member here, and I too also have Avmed through AT&T. Baratric surgery is not covered through my husbands benefits.  i'm a bit upset because I really need this surgery. I have no health issues, however my body has been taking a beating from all this extra weight. I'm currently 262.2 my heaviest weight. Before I had my son 2 yrs ago I was 232-238lbs. Since I've had him my weight has been climbing my knees hurt. I have heart palpations, and I even look different. I went to my PCP today and she advised me to do all the things I have done and been doing. Excercising, I've done Alli, Weight Watchers, Gym memberships, Phertmine, etc. and nothing has happened/   I would like to know if they approved you and what was the process like. Maybe you can guide me and give me some hope!!! Your response is greatly appreciated. Thanks 

 Hello Everyone.  I have read several post throughout the boards that a person has received a huge bill from the hospital after surgery even with insurance approval. How is this possible if you have approval from insurance company and a max out of pocket? I'm starting to wonder if I need to call my insurance company myself and confirm my responsibility. Is something not being mentioned when peeps are saying they got a huge bill???

Thanks!
Auburn