Aetna Advice Please

[Jason Can Do it! 21]

Hi guys!

I have my next consult with doc on 7/25 and expect all of my tests and file to be submitted to insurance then. I have Aetna Open Access. 3-month supervised weigh ins, letter of support from GP, all lab work etc is all done. My concern is I'm 36-37 BMI (have been for 2+ years) and also have high blood pressure. Everyone in docs office thinks I should be ok with insurance approval but I'm nervous about it because I'm so borderline with BMI and the one co-morbidity. Anyone in a similar sitch that has experience with Aetna or advice to share? Anything else I can be doing now to make Aetna say YES YES YES!?

Thanks, and congratulations to the many of you who have had such great success as a bandster!

Jason

[Sojourner 2,446]

The people who deal with the insurance companies know first hand if the paperwork looks adequate for approval before they submit it...and also if the documentation is borderline. You have to trust in them...

Aetna has changed their guidelines since I was approved...and perhaps their BMI/comorbidities requirement has also been changed. I know that I had to prove with 3 years of medical records the existence of a minimum of 2 weight related comorbidities for approval, as my BMI was 38 when my paperwork was submitted.

Try to focus on what the people who deal with insurance companies have told you...

Good luck and best wishes...

[dreamydaria 1]

I have Aetna, and have 39 BMI with high blood pressure and hypothyroid. My primary Dr. refused to write a letter of recomendation, and I was nervous that because of this I would not get approved. Apparently they accepted his "progress notes" instead. Keep in mind I did not visit the Dr. consistently. I was approved, after having to go the 3 months of seeing the Dr's needed to get the approval. My surgery is on July 3rd. Good luck, hope this helps.

[Jason Can Do it! 21]

Thanks dreamydaria... appreciate it, and good luck to you next week and beyond!

[th186607 0]

I was devastated to be told by a Aetna representative that they do not cover any type of bariatric procedures. My husband's job changed insurance companys to Aetna effective July 1, 2012 and We had UHC and just completed all the pre-requisites that UHC desired. Just over 6 months of HOOPS and now to be told Aetna won't cover by this rep. I find online that Aetna does cover. After 3-6 months. Why wouldn't this lady of known this? She almost caused me to jump overboard. LOL! Just saying.

I NEED this. I want the sleeve. I can't affort to have this done monetary wise. I have no other way but by insurance means. I am calling the dr. office tomorrow (as they were to submit my documentations to UHC Friday, July 7)... and now I have to tell them my insurance has changed. I am praying that this will happen for me.

Any advice or suggestions, please contact me I am desperate !!! th186607@gmail.com Thanks for any advice and help.

[NWgirl 574]

I was devastated to be told by a Aetna representative that they do not cover any type of bariatric procedures. My husband's job changed insurance companys to Aetna effective July 1' date=' 2012 and We had UHC and just completed all the pre-requisites that UHC desired. Just over 6 months of HOOPS and now to be told Aetna won't cover by this rep. I find online that Aetna does cover. After 3-6 months. Why wouldn't this lady of known this? She almost caused me to jump overboard. LOL! Just saying.

I NEED this. I want the sleeve. I can't affort to have this done monetary wise. I have no other way but by insurance means. I am calling the dr. office tomorrow (as they were to submit my documentations to UHC Friday, July 7)... and now I have to tell them my insurance has changed. I am praying that this will happen for me.

Any advice or suggestions, please contact me I am desperate !!! th186607@gmail.com Thanks for any advice and help.[/quote']

sorry to be the bearer of bad news, but just because the main insurance company covers WLS does not mean your policy does. Employers can choose to exclude wls on a policy for cost reasons.

My advice is to look at your specific plan benefits book under obesity treatment to see if surgrey is covered. I would guess the insurance rep is right... Don't go off of what you find online.

[exeznohz123 1]

I have Aetna with no medical history and only a BMI of 31% and got approved. You should be fine!

[Tuckersmommy10 14]

You can always re submit! I have aetna and had to do 6 months of visits and a few other things. When i first looked into WLS i got a rep that had NO idea what she was talking about, i had read online that they covered it for some policys. When i called back another time to check again i got another rep who was actually helpful and i learned they did cover it... and took the time to find a doc and hospital in my network who does it...