Aetna is covering VSG

jbmf · March 8, 2010

I talked with a lady on OH who gave me the downlow. I also spoke with an Aetna patient rep and she also said yes they are approving but not until all the legal paperwork is complete, sometime mid April. Okay, there is hope and a light at the end of the tunnel. Be patient.

Good luck to all.:001_tongue:

abcam · March 8, 2010

I called Aetna and the pre-cert department and they couldn't tell me anything. Maybe I'm not asking the right questions, etc. When I call, what should I ask and who should I speak with? I am so excited that I keep reading your post!!

jbmf · March 8, 2010

abcam, check your private messages.

piglet39 · March 9, 2010

If anyone knows anything knows anything about this, I would love some info. I am currently scheduled as a self-pay for Tuesday, March 16, and have Aetna. This would be so wonderful if Aetna would cover this.

jbmf · March 9, 2010

Hey everyone, this is what I know. Aetna reviewed their WLS policy on Feb 11. The girl at Aetna I spoke with today said they are going to cover the VSG now but Aetna needs to update the policy. It takes approximately 60 days to get this put in writing, thus about mid April. If anyone is interested, you can go on aetna.com to check for the updated policy. I do this several times daily. Don't want to miss anything. Anyway, click on healthcare professionals at the top, click on policy and procedures on the left. click on medical procedure bulletin, click on medical pcb, click accept, scroll down and either type in 0157 and search or click on "what's new". As of right now that's all I know. My Dr has submitted my paperwork. I will keep all up to date when I find anything else out. Best wishes to all.

mrlddst · March 9, 2010

Yes, please keep us posted. I called my doctors office on Friday to see if anything had changed and she hadn't heard anything.

mmcclure · March 9, 2010

I have been haunting the Aetna website since Feb. 11th. I am using a limited insurance policy to cover the surgery through Aetna and have been going nuts trying to find out if they would cover this or not. Anyway, the surgeon's office finally spoke with the supervisor and she said that they don't require precertification so the surgeon is going to get us started (my daughter and I are having it done) and plan on doing the surgery after mid-April. We have to pay the lot amount to the surgeon, but should be able to get it reimbursed if Aetna does indeed cover the sleeve next month.

I am sooooo excited. I have been afraid to get too excited because I wasn't sure how it was all going to turn out, but now that I know that there is a very good chance that it will be done, I can hardly contain myself!!! :confused1:

jbmf · March 9, 2010

I know. I've been haunting the Aetna website myself. My Dr. sent in my paperwork a week ago. I told the girl at my Drs. office to go ahead and submit for the VSG. I knew it would get denied. She called me today and said they did deny it. I told the girl in my Drs. office I spoke with an Aetna rep yesterday and that they have reviewed the policy and are approving the sleeve but not until mid April. She said we would resubmit. I have a hard time believing it may actually happen myself. It's like I don't want to get too excited because the let down would be so much worse but inside my head I am doing the BIGGEST happy dance. This next month is going to go so slow.

mrlddst · March 10, 2010

I called my doctors office today and they have yet to have anyone get approval from Aetna.....I'm keeping my fingers crossed.

agives130 · March 10, 2010

Hello Everyone,

I've been floating around the board for a few months now but never posted anything. I too have Aetna and guess what...drumroll please... I was scheduled to self pay next week but read jbmf's post last night. At 8am today I was on the phone with my case manager asking if she heard anything about Aetna approving the sleeve next month. She had not but promised to research it and call me back. Well, she just called me and said that she spoke with a very reputable source today and they told her that they are denying claims now and they can't leagally tell people they will approve it next month but indeed they will...Yaaaaaay =0) So mid April is the timeframe for approval! Now I can use that money for my new wardrobe!

Thanks a bunch jbmf!!

SW/CW/GW

305/305/140

5'6/f

Surgery Date: Hopefully sometime in April 2010 when Aetna Approves the Sleeve!

mrlddst · March 24, 2010

Any updates on this?? I'm am patiently waiting...its killing me. I have a doctors appt on April 23rd, I'm wondering if I should move it up.

mmcclure · March 24, 2010

I just looked at the Aetna site again and it still hasn't been updated. I have a doctor's appointment on April 9th and I think they are going to go ahead and start all the tests that the surgeon wants my daughter and I to have. Hopefully, when the policy is updated in mid-April, we will have already gotten a lot of the tests done and can schedule the surgery.

My Aetna is a bit different than most; I don't have to get pre-certified. So, apparently, I don't have to go through the 3 or 6 month supervised diet thing. But, Aetna itself still has to cover the procedure before the insurance will pay anything.

I sure wish they would hurry and get their policy updated. I can't find out how much our out-of-pocket costs will be (it is a limited insurance policy) until they have an allotted amount with the hospital for this procedure and the hospital can tell me how much it will be.

jbmf · March 24, 2010

Hey All,

I have not heard anything new except that someone else on OH also said their surgeon said Aetna would start covering in April. I know a lot of people are waiting (im)patiently. I am so ready for surgery! I also check the Aetna website daily. Hang in there everyone.:confused1:

abcam · April 1, 2010

Just checking in to see if anyone has heard anything new with Aetna covering the sleeve. I check their website several times a day hoping they've changed their policy. I'm hoping it will be next Friday. Looking at their updates for other procedure it looks like they post th on Friday - the new effective date seems to be Friday. I can't wait for this to happen!!