Have band need revision to sleeve and have questions about Aetna approval process

amm1211 · May 10, 2010

I have had my band for 2 years which was self pay and am needing a revision to a sleeve and now I have Aetna. I had my sleep study last week with no sleep apnea and my endoscopy last week with Dr. Kim, he said I have a slipped band which has been empty for weeks. His office submitted everything to the insurance today and said we will have to wait to hear from them. Has anybody else gone throught these steps with insurance, how long does it usually take to get an approval or denial?

jobigirl · June 9, 2010

Every Aetna policy is different. You should call the number on back of your id card to ask your specific questions. I have Aetna through AT&T and there are no limits in the policy for bariatric surgeries. I am in the beginning stages of band to sleeve revision. However, even though an insurance company may say they cover the process, there have been times when, after surgery, the insurance company refuses to pay. That is why the doctor must put you through all the paces to dot the i and cross the t, to assure that insurance will pay and you will not be left holding a bag of debt. Be patient. It will happen in due time. My new sleeve surgeon is making me gain 20 pounds to assure insurance payment. Imagine that!!!! So with all the tests, dietitian, psychologist, etc, appointments, it will be about two months before a surgery date can be set. The good news is that he removed all the Fluid from the band. I have thrown up at least once a day and sometimes more for the past four years. I will be so very very happy to get this band removed! Good luck to you as well.

mrlddst · June 9, 2010

I have Aetna and am being revised from a band to a sleeve. I have been approved with no pre requisites, but my case may be different from yours. I didn't have to go to any classes but I was going anyway as I had heard that they require people to do 3 mos with a nutritionist. Anyway, my doctor sent off for approval and next thing you know I get a letter and a call telling me that I have been approved. I meet with my doctor next week to talk about the surgery.

jobigirl · June 10, 2010

Lucky you! I wish I could get it today! However, I also have to quit smoking or the doctor won't do the surgery at all. He says smokers heal less quickly and the only two leaks he's ever experienced were in smokers. I need to quit anyway. Have bought a stop smoking aid and set a quit date.

dbernier01 · June 15, 2010

question re: your aetna approval for revision --- did you have a upper GI that showed band issues -- or did doc just submit with his determination that you needed a revision to the sleeve? I am trying to collect all my info so I can be prepared for the doc on July 7th

mrlddst · June 16, 2010

question re: your aetna approval for revision --- did you have a upper GI that showed band issues -- or did doc just submit with his determination that you needed a revision to the sleeve? I am trying to collect all my info so I can be prepared for the doc on July 7th

I don't know if you are referring to me but I had an upper GI back in 2009 and in 2008. I was having band slippage issues. I'm not sure what they sent it though. I was simply told that Aetna requested that my medical records be submitted so they could make a determination as to whether I could have the surgery.