Aetna POSII - I WAS DENIED

lhallab · 06-12-2008, 02:12 PM

I was told by my doctor today that Aetna denied my request for a Lap Band. My BMI is 37...because is it under 40, I am required to have a co-morbidity...I was diagnosed with sleep apnea. I have had all my tests, done my three months with a dietician. I have been working on this for a year and a half. I am so disappointed and upset. I called Aetna and they were not too nice about it. They told me to wait for the letter to explain why they turned me down. Has anyone ever appealled and won? What should I do?

It's_Christine · 06-12-2008, 03:12 PM

Wait for the letter and move forward from there. I was "denied" also and when I got the letter they said it was due to lack of signifigant weight loss on the 6 month required supervised diet. Well I lost 9% of my body weight but the reviewer missed that page. I got verbal approval in 24 hours and a letter in a week. So wait and see what the letter says, they may have missed your sleep apnea.

BobbieDoll · 06-12-2008, 03:22 PM

lhallab, I also had a BMI of 37 and was denied by my insurance company, Cigna, because I didn't have co-morbidities. Since you have been diagnosed with sleep apnea, you are a better candidate than I. My doctor called and requested a peer-to-peer with the insurance doctor. I was approved immediately that same day of the phone call. Have your doctor call and set up a peer-to-peer. Your insurance company will call your doctor's office and he/she can plead your case. I was told that after I start the appeal process, a peer-to-peer would not be an option so be sure to do that first. Your doctor's office has to set it up.
Good luck. Don't give up.

Flowerpurr · 06-12-2008, 03:34 PM

You need to send them a copy of your diganosis of sleep apena along with an appeal letter and your reference number.

lhallab · 06-12-2008, 03:45 PM

Thank you all for your help. It is so nice to have support. I will write all of this down and talk with my doctor's office.