Aetna approval

[JerseyGirl80 12]

Not to butt in but.. A weight history is a documented "weight history" from your doctors office. It's just the weight the doctor recorded whenever you've been seen for any reason, check-ups, gyno visits ect. This needs to go back 2 years so it shows that you have been obese for at least that long.

Also, Aetna paid almost all of my bill for the surgery and it was just under $25,000. The only bill I recieved was from the hospital for $500, everything else was covered. Anyone wondering about this needs to contact Aetna, your coverage and deductable could be different than mine was.

[littlerlou 7]

Not to butt in but.. A weight history is a documented "weight history" from your doctors office. It's just the weight the doctor recorded whenever you've been seen for any reason, check-ups, gyno visits ect. This needs to go back 2 years so it shows that you have been obese for at least that long.

Also, Aetna paid almost all of my bill for the surgery and it was just under $25,000. The only bill I recieved was from the hospital for $500, everything else was covered. Anyone wondering about this needs to contact Aetna, your coverage and deductable could be different than mine was.

Thank You! I am at the beginning stages and with wanting to switch insurances, Im so confused. Thank God for this board and its members..at least Im getting some direction! Ive put in a call to Aetna, BCBS, BCN and HAP just to see where I stand and what I need to do. Thank YOU!!'

[JerseyGirl80 12]

You're welcome.

FYI, for anyone thinking of changing their insurance mid-process, this could be a setback. You may have to start the process all over again meeting their requirements, and for all you know may be much harder to meet than the ones you have now. I'm not sure if all or any insurance companies would even recognize the steps taken before you were under their coverage.

I was originally scheduled for surgery in Jan 2011, less than a month before my surgery date my wonderful boss decided to change our insurance to the crappiest cheapest (for him) coverage he could find. As of the first of the year (Jan 2011) I would no longer be covered under Aetna. I freaked out but luckily my doctors office was able to get my surgery date changed and everything. I wound up getting surgery a week after I found out about the insurance change (Dec 13th 2010). Mind you I had just made it in enough time to stop my medications. But had no time for a pre-op diet. It was crazy stressful, here I am thinking I have time to prepare mentally, clean the house really good one last time, grocery shop ect, then all the sudden I had a week prepare everything. If I had waited I would have been screwed, (even though I still kinda am, my visits and fills aren't covered). But anyway, not only was my deductuble going to be almost $5,000 and the requirements for approval included 1 year monitored dieting and a repeat of all the tests I had to already go through, but it turned out that my surgeon wasn't participating. I would have had to find another doctor, and I couldn't say more good things about all of the doctors and staff at NJ Bariatric Center. Even though all my fills and follow ups are out of pocket, I'm glad I stayed with them, either way imy after care would have cost me almost the same using my new insurance, but would have cost me a whole lot more paying for the surgery.

[JerseyGirl80 12]

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[BaileyRose 13]

I thought that would be an issue for me too but it wasn't. Aetna won't accept the current year as a part of the two year history... So I needed 2010 and 2009. Well, I never went tongue doctor in 2009 so I was worried I would get denied. But luckily(ironic) I got strep throat when I was out of town in 2008 and went to the emergency room because I didn't have a dr, obviously, because I knew I needed an antibiotic. I'm so glad I went! Because other than that one time in 2008, I hadn't gone to the dr probably since 2004.

Anyway, all that to say, Aetna just wants your recorded weight for two years. It's not like they want to know you've been seeing your dr for two years to discuss your weight... They just want to make sure you've been overweight for some time and your not using weight loss surgery as a quick fix for some extra pounds you've put on the last couple of months.

I really love this posting, I read another one about Aetna here and it kind of brought me down. A lot of problems with the 2 yr weight loss history. Have any of you had that problem. I am a little concernd because I havent been with my PCP for 2 years and we never really dicussed weight loss. Everything I've done, was done on my own. But you guys keep me smiling and thinking positive

[BaileyRose 13]

Every insurance plan is different. My annual deductible is 2,500(for the family). And then they pay 90%. I had already met the majority of the deductible so on the day of surgery I had to pay $300. And then I was billed for the 10% which was around 2,500. And then $1,200 for the nutrition and psych fee. Total I paid right around $4,000 for my surgery.

[amaral1407 11]

I have to say Aetna EPO has been great!!! All my labwork, nutritionist (every 2 weeks), xrays are paid at 100%; .my psych exam was my copay of $30, and my co-pay for surgery is $1000. Now just the waiting for approval; they have received all my clinical reports so I'm hoping I hear Monday or Tuesday. As far as the 2 year weight history I have weight for May 2010, and than March 2009 my case manager at the surgeon office did not think this would be an issue. Wish everyone luck.

[amaral1407 11]

Well Aetna denied me not enough details, even though I had been going to my PCP monthly since July 8, Nutritionist every 2 weeks since August 1, walk the treadmill, and go to curves 2 days a week. I have lost 19 pounds so far!!! Really frustrated don't know what to do?

[rn2012 6]

Sorry for the bad news, What do they mean not enough details, did u not have a 2 year documentation of weight history

Well Aetna denied me not enough details, even though I had been going to my PCP monthly since July 8, Nutritionist every 2 weeks since August 1, walk the treadmill, and go to curves 2 days a week. I have lost 19 pounds so far!!! Really frustrated don't know what to do?

[amaral1407 11]

What I was missing it my 3 month detailed report from the Doctor, I guess they sent July 8 but than only sent nutritionist report. I called Aetna and got a their fax appeal number and my dr is going to submit a more detailed report. Hope this is hleping

[rn2012 6]

Oh wow, it looks like your dr's office dropped the ball, hopefully you will get approved with new info

What I was missing it my 3 month detailed report from the Doctor, I guess they sent July 8 but than only sent nutritionist report. I called Aetna and got a their fax appeal number and my dr is going to submit a more detailed report. Hope this is hleping

[Iwant2Bthatgirl 28]

I'm at the very beginning of this process (just starting to consider having WLS). Does anyone know if Aetna will cover fills?

Thanks!

[amaral1407 11]

I believe every plan is different; mine will cover fills for the first year.

[llband2011 2]

I called Aetna too today. My surgeon's office explained that the information for Aetna goes through their nurse's line. They told me that I talked to customer service and they wouldn't see it. That made me feel better. My surgeon's office also said Aetna usually takes up to 7 days.

:(Ok now the stress has begun. I called Aetna to check on my approval that was submitted last week and they informed me that they have not yet received my clinical records!!!! Now they have to be resubmitted everything, the good thing living in the state of Washington they have a two day turn around time for surgery approvals. So keeping my fingers crossed I will know something by next Monday..

[shaah 0]

Well Aetna denied me not enough details, even though I had been going to my PCP monthly since July 8, Nutritionist every 2 weeks since August 1, walk the treadmill, and go to curves 2 days a week. I have lost 19 pounds so far!!! Really frustrated don't know what to do?

OMG!!!! I am super sorry to hear about this set back. but thats all it is sweetie, you WILL get approved. Hoping, praying, and wishing for the best