Aetna In Ny

[Anali11 9]

Anyone have positive or negative issues with getting approval from Aetna? I am starting my journey tomorrow with an appointment to my primary care physician!

[Sojourner 2,446]

Anyone have positive or negative issues with getting approval from Aetna? I am starting my journey tomorrow with an appointment to my primary care physician!

I did not have any trouble getting my first letter request approval through Aetna, but I believe they have changed their approval criteria since I had my surgery.

My doctor has alot of experience dealing with them, and he stressed the importance of my comorbidities and my BMI at the time. At that time, you had to complete the 6 month medically supervised weight loss program, which I now believe has been shortened to only 3 months.

When I was approved for surgery, if your BMI was under 40, you had to prove existence of a minimum of 2 weight related comorbidities with submitting 3 years worth of medical records which needed to include 3 years of recorded entries of your weight.

Best wishes as you begin the journey!

[PatchIP 8]

I was approved on the first attempt however, they do like to screw around with you & they wait until the last minute to approve you. I was finally approved within a day or two of my surgery date. I was ready to cancel it because I wasn't willing to take the chance of being self pay for this.

That really angered me because Aetna kept asking for additional information. For example, I had my CRNP write a list of my weights over 2-3 years. At the last minute, Aetna decided they needed the actual progress notes from my doctor visits. I also had to have an additional letter written by my CRNP, who is my primary care provider, that she agreed with the surgery, blah, blah, blah.

Just be prepared for them to play the bariatric surgery game with you. I wasn't prepared for that and as a nurse, it made me angry because I know how to navigate the health care system. I really feel sorry for patients that don't have that benefit.

Good luck to you!

[Anali11 9]

Thanks for the help guys!!