Aetna *** approval????

[rn2012 6]

Hi,

I have aetna health manitence organization and a representative states that lap band is covered if its medically necessary. Im 5"8 270lbs with a bmi of 41..My ? is will Aetna still make me go thru hoops to get approved? and whats the quickest approval time from Aetna???

[sweetpea61956 6]

I have Aetna too. I had to go to nutritionist for 4 months and prove that I had fought my weight for 2 years...but after that it took less than a week to get approved. And honestly the 4 months was time well spent. I learned so much about myself and my eating habits that I was really really ready for the band

[Scott 72511 0]

I have aetna and I was just banded july 25th. jumped thru hoops since january to get approved. all kinds of tests, and weight supervision for at least 3 months by a nutritionist. good luck on your journey!

[SIPS in Seattle 345]

I have Aetna, for me they required 3mo supervised diet and 2 years history of being over 40bmi which I didn't have So i was denied twice. Had to enlist the big boys at obesitylaw.com for help (the surgeon's office told me about them and Allergan footed the bill) They were the nicest folks and after two appeals, I was finally approved! woohoo

Good Luck!!!

[saints=love 1]

typically its never quick when you go through your insurance but if you pay it seems to go faster also most insurances want to see if you attempted weight loss or have a weight loss attempt documented my insurance is different but so far my journey has been going on since September && im still not banded lol im going to be banded in September damn near a whole year! but take it from me all we have in life is time so why not wait however long it may be as long as iknow my decision will better my life && the rest of my time its so worth it goodluck to you && your Journey<3

[Bluegreen 0]

Just know that your Aetna policy could be different from others. They can provide you with the specifics of your plans coverage of bariatric surgery. It should say what types of bariatric surgery they cover and what the criteria is for gaining approval. They need to give you something more specific than just saying it must be medically necessary. For my insurance, it's a 6 month process. According to my surgeon, even if you are self pay, it's still about 3 months. I'm sure they are exceptions, but it's not a fast process. I agree with sweetpea - it's time well spent.

I'm 4 months into the 6 month process for my insurance company. I'm trying to be very careful to meet all of the plan requirements, but I'm so worried I'll miss something that will result in a rejection.

[girly831 8]

I also have Aetna, and I went thru the same thing. I have boderline BMI of 35, but I also have 3 comorbities and was denied. Already contacted obesitylaw.com for help but have not heard from them yet. I hope they can help me get approved. Who paid for it? I'm not sure who Allergan is. Thanks for any info.

I have Aetna, for me they required 3mo supervised diet and 2 years history of being over 40bmi which I didn't have So i was denied twice. Had to enlist the big boys at obesitylaw.com for help (the surgeon's office told me about them and Allergan footed the bill) They were the nicest folks and after two appeals, I was finally approved! woohoo

Good Luck!!!

[SIPS in Seattle 345]

Allergan is the maker of the lapband.

[bellam 0]

I also needed to show that I was struggling with my weight for more than two years. I was then denied my first time because my doctors office messed up and did not write my weight on the chart for one of my visits. I also want to add that I was denied within two days. So I waited another four months and re-submitted my paperwork then I got approved. This approval took two weeks, I guess it takes them longer to approve patients for this procedure.

[Jules1981 0]

Hi,

I have Aetna and I have a bmi much higher than yours. I ended up having to do a couple of things prior to getting approved. I think that you will need to call the facility you are thinking of going to and ask them about the insurance requirements. Another thing that you can do is go to Aetna's website and read their requirements for coverage. It was kind of tricky working through their website but once you find the requirements they are not too difficult to understand.

Hope this helps and best of luck.

Jules

Hi,

I have aetna health manitence organization and a representative states that lap band is covered if its medically necessary. Im 5"8 270lbs with a bmi of 41..My ? is will Aetna still make me go thru hoops to get approved? and whats the quickest approval time from Aetna???

[DMDubey76 1]

I have Aetna Choice POS II (To me "POS" stands for something far different then what they say it stands for ). Anyhow, I started the "journey" on June 6, 2011. I called them prior to even going to a seminar and they were kind enough to email me a packet of all the information. They pay 80% of the surgery. The criteria they list is:

If you have 40+ BMI (check)

Or:

At least 100 lbs. overweight (check)

Co-morbidities (i.e. sleep apnea, diabetes, hypertension, etc.) (none here, thankfully)

After you meet either/or both of those criteria(s) then you move on to the "preliminary" doctor visits:

-Psychiatrist visit and letter of approval for surgery from him/her

-Sleep Study (plus a follow-up visit where they went over the results)

-Cardiology (I also had an echocardiogram/ultrasound of my heart)

-At least one support group visit

-At least 2 nutritionist visits

-At least 1 dietician visit (mine was 1 day split into also visiting the surgeon)

-Blood work

So that's where I am with my Aetna. I did ALL of the above requirements. Bristol Hospital recently sent my claim to Aetna. Now I'm waiting for approval.