Re: NEED HELP AETNA APPEAL/who's been approved?

[Guest guest]

> Hello everyone, I am preparing my first appeal with Aetna

UShealthcare HMO, they denied .........Gastric resrict proc, W/

Gastric bypass for morbid obesity W/sm bowelrecon

to...............Gastrectomy, partial,distal,with roux-en-y

reconstruction................saying they were considered

experimental,investigational, orineffective therefore

excluded..............................So I know I need to appeal but

where do I start? Thanks in advancefor any advice you all might have,

TTFN, Lori C IN NJDr Herron Jan 26 Aetna Ushealthcare HMOBMI 61

Hi Lori, I had to reschedule consult with Dr. Herron because I just

found out that MY Aetna Policy has a " no obesity treatment " exclusion.

This will apparently change January 1st. I was expecting some

problems with Aetna but not so soon! Good luck with your appeal and I

will check future postings to see how you make out.

[Guest guest]

> Hello everyone, I am preparing my first appeal with Aetna

UShealthcare HMO, they denied...saying they were considered

experimental,investigational, orineffective therefore

excluded..............................So I know I need to appeal but

where do I start? Thanks in advancefor any advice you all might have,

TTFN, Lori C IN NJDr Herron Jan 26 Aetna Ushealthcare HMOBMI 61

> where do I start? Thanks in advancefor any advice you all might

have,

> TTFN, Lori C IN NJDr Herron Jan 26 Aetna Ushealthcare HMOBMI 61

Lori,

The place to start, I think, is with Dr. Herron, who should be able

to explain why in his opinion the procedure is not experimental or

" investigational. " I have prepared a draft of an appeal letter to

Aetna, which denied coverage to me for the same reason. I have asked

Dr. Gagner to review it and to make sure that the medical stuff in it

is correct. I am a lawyer for an insurance company so I think the

legal arguments I made are okay. If the appeal is successful, I plan

to make the letter available to anyone who wants it.

It is not likely that my appeal will be decided before your deadline

for appealing has passed. (The denial letter should tell you how much

time you have; it varies from policy to policy and probably from

state to state.) So once Dr. Gagner has gotten back to me and I have

gotten the appeal in final form, I will send you a copy if you send

me your address.

Deborah

lap BPD/DS 11/6/00 (self pay)

pre-op BMI 42

presen BMI 37

34 pounds gone