Question:
Does anyone have Aetna POSII?

I have them and they have denied me because they say I have not had 6 months of supervised weight loss and exercise.I have had all of this and it is documented but now they are telling me because the diet and the exercise was not at the same time, but it was. If anyone can offer any suggestions on what I should do it would be greatly appreciated.    — BETCBOO2 (posted on January 12, 2007)

January 12, 2007
Gee I must have lucked out, I didn't have any of these problems. APPEAL!!!! and don't take no for an answer.
   — Diane C.

January 12, 2007
There are appeal letters on this site that you can use. Also have your doctor submit more documentation. So many people are denied but then get approval after an appeal!!
   — longislandamy

January 12, 2007
Your surgeon's office should be appealing the decision. Dont get discouraged or to upset. I know that its disappointing, but that is just how they do things. They almost always deny on 1st letter. If you have a good surgeon who has a good experienced staff, you wont have to do much. They should be taking care of the paperwork and letting you know of the outcomes. Usually, the surgeon has to write a letter of necessity and submit it along with the other documentation for review/appeal. POSII is paid the same way as the standard HMO, so dont worry to much. Keep your chin up
   — _blue_

January 12, 2007
I agree with the previous posts. APPEAL, APPEAL. I did not have Atena, I have Healtnet and was intially denied because they said that my surgeons office did not submit documentation of a six month supervised dietary program. When the surgeons office told them that they would send in more information they were told that it was too late and that I would have to file a formal appeal. My surgeons office did not handle the appeal for me. I had to do it myself. I went to the surgeons office and got copies of everything that was submitted to the insurance company. I wrote my appeal letter and submitted additional documentation from LA Weight Loss and Curves for Women. Once my appeal letter was received I was approved. I just had my gastric bypass surgery on 1/9/07 and I am doing well; just trying to get used to all of the changes. Do not take no for an answer! If you have decided to have surgery in the best interest of your health put up a fight. If you would like a copy of my appeal letter please email me. I wish you all the best. -- Sharon
   — smiller8

January 13, 2007
I have BCBS of IL. Ijust got approved, after 18 months and 2 denials & 1 appeal. I have lots of suggestions. If you want to e-mail me, it's ok. [email protected] I had my Dr appt yesterday & expect to have surgery about the first of February. I know it was really tough & hard to hang in there, but I am totally conviced that it will be the best thing for body & my future. I'll do what I can to assist in that journey. MKK
   — asinmouse

January 14, 2007
I ALSO HAVE THE SAME INSURANCE, HAD SURGERY MAY/04/06 ,BUT MY DRS OFFICE DID A 3 MO WEIGHT REG, PORGRAM STARTED AT 237/NOW I WEIGHT 165,THIS MAY NOT HELP BUT I WOULD LOOK FOR A 3MO PROGRAM, BUT IF YOU WANT IT BAD ENOUGH DO IT STEP BY STEP. DO YOU HAVE A COPY OF THE POLICY? PLEASE READ IT CAREFULLY ,BUT DONT GIVE UP NEVER, THAT PROCESS OF THE WHOLE JOURNEY IS SOOOSOOOO STRESSFULL,BUT I WOULD LOOK FOR A DOC WITH A 3 MO PROGRAM,NOT UNLESS YOU ARE SET ON ONE ALLREADY, WHITH THE 3 MO YOU JUST FOLLOW WHAT THE DOC SAYS AND EVERTHING WILL BE OK.GOOD LUCK YOU NEED MORE HELP OR INFO SEND ME A E-MAIL KATRINA
   — katrina

March 3, 2007
I have Aetna POSII and finally got approved after two years. I, too, had to do the 6-month supervised weightloss with a registered dietician. The dietician just made sure EVERYTHING was documented and made sure I had a food and exercise diary for those six months. They are VERY hard to get approval from....just make sure all your paperwork is together -- especially the food and exercise diary and your dietician and surgeon have everything included. Best wishes! Tina :)
   — smom

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