What to do if you get denied?

Ok so I called my dr to make sure they submitted my paperwork and info to my insurance company.  The lady called me back and left a voice mail saying the submitted my paperwork on 9-4-08.  (yay!) but then she made it a point to mention that they can deny me.  

 

Here is the story, i had such a hard time explaining to them that i wasnt required to have 5 yrs medical history.  (because i cant find year 2003) i looked up on aetna's website and no where on it does it say YOU MUST HAVE 5 YEARS OF RECORDED WEIGHT!

 

So.....with going over this with her, she was a little pissy with me.  Anyway, it is done, and now I can do nothing but wait.  

 

Im so stressed.  With school, work, me and chad working different hours....and now this!  OMG!!  what is a girl to do?

It all depends on what KIND of policy you have with Aetna and furthermore if there are any exclusions written into the policy by the employer who has issued it.  I have Aetna HMO and was required to have a 5 year history of my weight however, a simple statement of my weight from a Weigh****chers meeting, or gym membership (which is what I had) or of course a physical from a doctor worked.  My surgeon did say that if I was only missing 1 year he could go in front of the insurance people and basically plead my case if that was the ONLY reason for denial.  Especially if it was 5 years ago and you have demonstrated a consistent pattern of being MO since then.

And anyway, 2003 shouldn't matter because you have 04, 05, 06, 07, and 08.  That is 5 years.  It doesn't have to be 5 full calendar years (at least, it didn't for me - I was missing 2003 also).

well they called me today and i found out they need specific paperwork showing my 6 month diet and i have to have a psy evaluation.  great.........

Yes, that is a very common insurance requirement.  Your surgeon should have documentation of your doing a 6 month diet (or he should be having you do one).  I know it's frustrating because you want it done NOW but just think...it's the last time you'll ever have to "diet" in your life. 

Our hospital sets up all the new people in the program with scheduled nutrition meetings, tests, and other things, and they get the approval for you.  It made it fairly easy with the checklist, and all their help.  I also had to do 6 months of nutrition meets, a psych eval, and a bunch more.  It all works out in the end.