Flowerpurr

Wow sounds like we are going through the same thing almost. My Dr.'s office finally submitted after three weeks. I have been done with my three month diet for almost a month. I did lose 36lbs which is good. I also have Aetna and they are giving me the run around as to where my file is and what they are waiting for. They say they need more info but the nurse said they have everything they need and like to send people on a wild paper chase to delay the process. I don't know if this is true. Good luck and keep me posted on your progress.

I have Aetna as well and I am waiting to here what is going on. I called and they said it's assigned to a reviewer. Which insurance company denied you. Find out exactly what you did wrong on the six month diet. I am sure you can appeal and win. That is just there way they think people will give up. But don't give up. Fight Fight Fight Good Luck

Hello Everyone, Well my Dr.'s office finally submitted the paperwork in. But they didn't submit my diet according to Aetna. They only submitted a summary letter of it. Did anyone have that happen to them and they had to provide the medical records? Also does anyone know the number to the predertimantion section? I just want to call and find out what is going on. I don't want to talk to member services.

Hello Everyone, I have a question for you. Did anyone have to show proof of previous diet's tried? I told my Dr. which diet's I did in the past and she wrote them in the letter to Aetna but the surgeons office called and asked what diet's I have tried in the past. They didn't see the letter from my Dr. I asked her do I need to provied documentation she said she didn't know she is just the office manager and if I do she will have the nurse call me. Well if I do I don't have any! La Weight Loss went out of business and Jenny Craig was when I was 16. Teen Weight no more was when I was around 14. I did the Zone Diet on EDiets along with Eating for Life on there to. I did Weight Watchers but my Mom went to the meetings and I just followed along with her. So if someone can please help that would be great! Thank you!

Well thank you all for your help! I pray the nurse sends in my paperwork. She has been sitting on it for three weeks now. I am sure Aetna will be faster than her. Of couse she told me 30 to 60 days for approval or denial.

Wow congratultaions on your fast approval. My Dr.'s office still hasn't sent in my information to Aetna yet so I am still waiting for that to be done. But good luck with the surgery!

Try this site it may be able to help you. OAC

Clinical Policy Bulletin: Obesity Surgery <DIV class=body id=AdjustableContentLayer>

Well I won't be hearing anything unless my suregons office submits it. As far as I know they still haven't done it. But good luck to you! I hope you get approved the first time around.

Hi Drew05, I spent $1400 on the diet. $75.00 on the PCP and $20.00 on the psych eval and $100.00 on the exercise phys and dietecian. Oh $25.00 on the suregon. That is what I have spend thus far. I hope that helps.

Aetna no longer required a 5 year weight history it's only two. They changed their policy. Here is a copy of it. <TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD id=spacer width=16 rowSpan=3> </TD><TD class=contentbucket vAlign=top width="100%" rowSpan=2> Clinical Policy Bulletin: Obesity Surgery <SCRIPT src="http://www.aetna.com/assets/script/search_keyword.js" type=text/javascript></SCRIPT> <NOSCRIPT> <!-- browsers or browser setting that can't read js will have this feature disabled --> </NOSCRIPT> Number: 0157 <TABLE cellSpacing=0 cellPadding=0 border=0><TBODY><TR><TD>Policy Note: Most Aetna HMO and QPOS plans exclude coverage of surgical operations, procedures or treatment of obesity unless approved by Aetna. Some Aetna plans entirely exclude coverage of surgical treatment of obesity. Please check benefit plan descriptions for details. Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Silicone Gastric Banding (LASGB), Biliopancreatic Diversion (BPD) and Duodenal Switch (DS) Procedures: Aetna considers open or laparoscopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB or Lap-Band) medically necessary when the selection criteria listed below are met. Selection criteria: Presence of severe obesity that has persisted for at least the last 2 years, defined as any of the following: Body mass index (BMI)* exceeding 40; or BMI* greater than 35 in conjunction with any of the following severe co-morbidities: Coronary heart disease; or Type 2 diabetes mellitus; or Clinically significant obstructive sleep apnea (i.e., patient meets the criteria for treatment of obstructive sleep apnea set forth in Aetna CPB 004 - Obstructive Sleep Apnea); or Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management); and [*]Member has completed growth (18 years of age or documentation of completion of bone growth); and [*]Member has attempted weight loss in the past without successful long-term weight reduction; and [*]Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen): Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record. This physician-supervised nutrition and exercise program must meet all of the following criteria: or [*]Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions: Consultation with a dietician or nutritionist; and Reduced-calorie diet program supervised by dietician or nutritionist; and Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and Behavior modification program supervised by qualified professional; and Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.) </TD></TR></TBODY></TABLE> </TD></TR></TBODY></TABLE> Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records;

Hello, I am going through it now. You don't need a medically supervised diet for the past two years. You need to have done a diet in the past two years that was medically supervies otherwise you have to do either a three or six month diet depending on how much money you are willing to spend. I did the three month route and spent a ton but worth it as long as I get approved. Good Luck.

Hello Timetobandme, No I am still waiting for the office to send in my paperwork. They said they had a few emergency surgeries and would look it over in a couple of days. Well that was Wednesday. So I just sit here and wait. I am tired of waiting though. I am still going for weekly weigh-in's just in case Aetna wants a six month diet instead of a three like the say. I live in Lake Bluff. I would love to join the group.

Hello, I was told it is harder to get approved in Illinois for LapBand surgery than any other state. Has anyone run into this problem that lives in Illinois? Also what insurance did you have? I have Aetna Open Access II I know they are hard to begin with but are they even harder in Illinois?

Hi Jen, I know what you mean. But my suregon said it is harder because of Illinois laws. It makes no sense to me.

Hi Timetobandme, My name is Nicole I am am waiting to be approved. I live in Lake Bluff and going through Condell with Dr. Watson and Otto.

I have heard Dr. Denham is the best around. I am currently going through the approval process. My suregon is going to be Dr. Watson out of Condell. What insurance do you have?

Laura, Congratulations on being approved. I have a question for you. Did you do the six month or three month diet? Also did you have an co-morbities?

I feel the same why. I sent everything to the suregons office on Friday and the nurse said she would either call me Monday or Tuesday. It is now Tuesday and I called and they said the nurse is on the phone and I will have her call you. The only problem is this nurse doesn't call back. I have Aenta PPO and live in Illinois two stikes against me. My Dr. said that it is very hard to get approved for surgery in Illinois and it takes about 30days. I have done my 90diet but still doing it just in case the insurance want's more proof. So at this point I am at 120days on Thursday. I to want to take control of the situation and put the paperwork in myself. I know it would of been done by now. But the name of this came is waiting.

Most hospitals have to bill your insurance to find out what they are going to pay and what you get stuck with. I am sure you will be ok. It's not like it's a plastics suregons office where they want the month up front. I know with my insurance they don't make you pay out your deductiable all at once. They base it on the amount the bill costs and they bill you for a protion and they pay the rest.

Love you can ask for a low profile port and no one will be ablet to tell and you probally won't be able to tell either. Besides I don't think any Dr. in their right mind would agree to put the port below the bikini line. They just don't do it that way. Trust me get a low profle port and you will be fine.

Hello, I went to my suregon's office on Firday and he said it is hard to get approved in Illinois? Is this true? I have Aetan POS II and wanted to find out if anyone had a hard time getting approved.

Hi Dandy Andy, Thank you for the information. I have a couple of questions for you. 1. Did you do the three or six month diet? 2. If you did the three months did you have to prove you did six in total? 3. What address did you send it to? I may do the same since I was going to submit on Friday. Congrats on the weight loss. I to have taken off over 30lbs but on an all Protein diet. I need the band before I start putting weight back on.

Does anyone know if Aetna will pay for an Upper GI? My Dr. wants me to have one done before he will perform lapband surgery. I hardly ever get acid refulux so I see this a pointless.

Did Dr. Denham make you have an upper GI before you had the surgery?