Anyone Have Aetna?

[Kerra 4]

I have been waiting for approval/denial from them for two weeks. Anyone out there know how long they take? I am scheduled for surgery on April 23

[yelorz 9]

I have Aetna Managed Choice POS (Open Access). They won't pay one red cent toward lap band surgery. They'd rather pay for my knee replacement and see me go blind and have my toes removed one at a time. I hate them.

[Kerra 4]

I don't like the sound of that! I have Aetna choice POS II. Not sure of the difference..... I can't believe they will not cover it for you. Will they cover ANY bariatric surgery?

[yelorz 9]

^{No. They'll give me a discount if I join Jenny Craig or something like that. But they won't pay for any bariatric surgery. (And I don't know why this font size is so small - I set it on 18 point. Arggggh!) I hope you have better luck with them!}

[TexasSoccerMom 26]

I have Aetna Open Access, and they cover WLS. I am on my last month of a 3 month diet plan, so I haven't actually been approved yet, but my insurance coordinator at True Results keeps telling me it will be approved easily.

[yelorz 9]

Wow! Perhaps I need to go to True Results and have them handle the insurance part for me. So did Aetna require that you go on a 3-month diet and then they would approve the surgery? Maybe I shouldn't give up hope just yet.

[yelorz 9]

I have Aetna Open Access, and they cover WLS. I am on my last month of a 3 month diet plan, so I haven't actually been approved yet, but my insurance coordinator at True Results keeps telling me it will be approved easily.

Did you call Aetna yourself at all or did you have True Results deal with Aetna? I would love it if they would pay for the surgery - or least part of it!

[michele39 7]

I have Aetna and they approved me within a couple days of finishing my 3 month nutrition counseling and pre op work up

[Kami76065 19]

I have BC/BS and they told me they don't cover it, but true results knew what to say, and got it done. BMI had to be at a certain level and all that though.

[TexasSoccerMom 26]

My requirements since I have no comobidities were to participate in an organized multidisciplinary surgical preparatory regimen of at least three months (90 days) 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:

1. Behavior modification program supervised by qualified professional; and
   
2. Consultation with a dietician or nutritionist; and
   
3. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit.; and
   
4. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
   
5. Program must have a substantial face-to-face component (must not be entirely delivered remotely); and
   
6. Reduced-calorie diet program supervised by dietician or nutritionist.
   

I also had to have a psychological evauluation and have documentation from my PCP or OB/GYN the presence of severe obesity that has persisted for at least the last 2 years.

[yelorz 9]

My requirements since I have no comobidities were to participate in an organized multidisciplinary surgical preparatory regimen of at least three months (90 days) 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:

1. Behavior modification program supervised by qualified professional; and
   
2. Consultation with a dietician or nutritionist; and
   
3. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit.; and
   
4. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
   
5. Program must have a substantial face-to-face component (must not be entirely delivered remotely); and
   
6. Reduced-calorie diet program supervised by dietician or nutritionist.
   

I also had to have a psychological evauluation and have documentation from my PCP or OB/GYN the presence of severe obesity that has persisted for at least the last 2 years.

Thanks! I'll see what I can do now. You've been very helpful.

[Kerra 4]

Just found out Aetna approved me! Keep trying!!!

[yelorz 9]

I'm so happy for you - you must be thrilled! I submitted my insurance information to True Results to see if they can help me. I also made an appointment for a consultation at True Results for this Friday. :-)

[kvr1977 28]

Hi yelorz, I have Aetna NAP. My plan covers lap band also, but my situation is exactly like Texassoccermom, I have to go thru the exact same regimen. I too am going with true results, they have been absolutely wonderful. The lady at true results is doing all the dirty insurance work on my behalf. I think it depends a lot on what type of plan you have. I will keep you in my thoughts. Take care.

[kvr1977 28]

Just found out Aetna approved me! Keep trying!!!

Congrats Kerra!