tempted to do self pay even though i have insurance

[stromgardgirl 0]

Ok so I have decided on my dr which I feel is a very good decision. He is Dr. Nicholson in Plano. I do have insurance which I'm. Going through. I tried calling my inssurance to find out exactly what I needed and she said she wasn't equipped to tell me what aetna needed specifically and I would need to wait to hear from my dr. I have a feeling the next 3 months are going to be trying.

[sleevesearch 14]

This is what AETNA sent me, your particular plan may be different, but I believe the clinical criteria is the same.

"We determine coverage based on your plan benefits and clinical criteria.

For details on clinical criteria, see Clinical Policy Bulletins, which

can be found online at Aetna ? Health Insurance, Dental, Pharmacy, Group Life and Disability Insur.

1. Go to Aetna ? Health Insurance, Dental, Pharmacy, Group Life and Disability Insur.

2. From your home page, select 'Health Care Professionals'.

3. Select "Policies & Guidelines" on the left hand side of the page.

4. Next choose "Clinical Policy Bulletins".

5. Select 'Medical CPB'.

6. Click the "I accept" box to proceed.

7. In the box entitled 'Search CPBs', enter policy number '0157'

Please review and discuss the clinical policy bulletin with your doctor.

Is precertification required?

Yes, the procedure must be precertified by your doctor with Aetna's

Patient Management department. If your doctor does not precertify this

procedure, your benefits could be denied.

Please have your doctor contact Aetna's Patient Management area at the

toll-free number for precertification listed on your member ID card."

[laylasmojo 10]

I'm not going to tell you that the next few months are not going to be trying but... this is the way I look at it, find out exactly what your insurance requires when you go to you drs apt and if you feel you fit the critera to get covered then just jump through the hoops to get them to pay. Because think of all the things you are not doing since you are overweight......now think of all the things you could do with the money you save by having them pay (which you are really paying by paying all those damn premiums) and really you have waited as long as you have so what is three more months? well good luck in your choice and your journe!

[Brian66 85]

I have Aetna and I really didn't find the process to be too bad. I visited the surgeon for my first consultation on April 24 and I was sleeved on July 13th. My biggest complaint was the surgical coordinator in my surgeon's office. I found her to be inexperienced, unorganized and unresponsive. Once I realized this, I started calling Aetna myself to check on the status of my approval. I found them to be generally helpful and responsive.

[a.walker 2]

I self-paid even though I had insurance. My insurance generally sucks, and I have no faith in them, though. The minute I found out they require a documented 6 month diet and exercise plan within the 12 months before surgery, I decided I would look into self-pay. I went to Mexico and the self-pay price was about the same as what I would have paid out-of-pocket with my insurance. Maybe less, because I didn't have to pay for a sleep study, EKG, labs, psych. eval, etc. None of those things were covered with my insurance, which is ridiculous but true. I'm not saying this is necessarily something for you, but just that it isn't completely crazy (I hope!).

[stromgardgirl 0]

Thank you everyone. I will see how many hoops I have to jump through for the 3month multi. I can stand to wait that much longer. I really don't have the money to do self pay, but that insurance person ticked me off today. I would much rather take a vacation with that money instead of paying off a loan.

I have heard positive things about aetna so hopefully it won't be that bad.