Aetna Aetna Aetna

[MommyTawnie 3]

Hello all I am Tayna. I am a 26 year old mother of 2. I stand 5'3 and weigh in at 237 right now. My BMI is at 42 1/2 is what the nurse told me yesterday. I started my journey back in June for a 3 month weigh in. Only to find out at the end of the 3 months I was suppose to be seeing an exercise therapist as well as a dietician for the 3 months charting if I was doing it that way. Knowing that I would have to start over if I wanted to do the 3 months I went ahead and decided to do the 6 months of consecutive charting. I have 2 months left and I am feeling more more stressed over the whole thing. My biggest fear is being denied for the surgery through insurance. I don't have the money to pay for surgery out of pocket, and insurance covers at 80% leaving hubby and I paying the other 20% which is more in a price range we can afford. I have done my pych evaluation and just had my meeting with the dietician yesterday. The only thing I have left is these last 2 months. Out of experience did you have problems with your insurance approving for surgery, or did it go pretty quickly?? :thumbup::confused::confused:

[6kiddos 18]

I was told I had to have pulmonary clearance and cardiac clearance also. My last appt for the 6 mo program is this Friday! (woohoo!)

I have everything in except the last appt from my PCP and his letter. I am also waiting on the pulmonary clearance. (though this is unclear on whether or not I really need this...it might be for the surgeon only because I am close to the 50 bmi. I am at 45.9 after the 6 mo diet/exercise).

I am worried about being denied as we cannot afford the surgery otherwise. We hit our family ded. in June ($10k!) and this surgery would be 100% covered. We'll see. =)

good luck to you!

[peatie 4]

Hi Tanya. We seem to be on the same schedule as i'm looking to do the surgery in Dec, and praying hard I will not be denied. I did the 3 mo deal, but believe me have called and called and spoke w/Aetna several times to BE SURE what their requirements are for approval. I know they have their 'check list' but they don't say what is totally required in each of the chart notes...and someone was denied recently because there wasn't 'enough' information from the Dr's notes during the 6 months... So I would ck and dbl ck what INFO they fully require for each Dr's visit. Simply stating that you were counseled on weight loss is not gonna cut it. The Dr needs to be very specific and go into detail about the appt.

Good luck. I'm rooting for you!!

[DougNichols 124]

My dietitian told me that she was my "exercise therapist" and "behavioral therapist" as per the requirements. Doesn't make any sense, but they seem to know what they're doing.

[MissPrissBecky 0]

I also have Aetna insurance and will be getting the Sleeve on Oct 5th. My BMI is 41 and I have no health issues. (BMI has to be 40 or above if you have no medical problems or 35 or above if you do have medical problems that can be helped by weight loss in order for AETNA to cover the surgery) I went to my nutrition classes once a month for 3 months and AETNA approved my surgery. You should not have any problems being approved for the procedure. Good luck!

[MommyTawnie 3]

Thanks all I met with the surgeon and the check list they provided covered more details for 3 months and the 6 month charting. My PCP is on top of everything. He has had 2 other patients go through him for the charting and both were approved with the first try.. I am excited to get through these next 2 months. All though it will be pushing it for approval and surgery I am confidant that I will be approved after talking to friends with the same company/insurance, and reading post on here. I am really looking forward to the new journey. Even though it is taking a bit longer then I had hoped the way things are looking now I will have the surgery before the end of the year I have been instructed to call atleast once every 3-4 days to see where I am at in the approval process, and to provide any information they may need to go with it.. I had my yearly exam back in August it included all the blood work, EKG as well as x-rays. Everything looked good and he was very confident that I would make a good canidate for the surgery. Fingers crossed it goes as smoothly for me as it has for others...

[6kiddos 18]

is Aetna requiring a Pulmonary clearance for you? I am just curious because I have left tons of messages with the ins. lady at the surgeon's office and still no call back. I have my LAST appt with my PCP today! (6-month) woohoo. I am still working on that pulmonary clearance though..sigh.

[MommyTawnie 3]

They haven't mentioned anything about a pulmonary clearance, all of my testing was done for a routine yearly exam. We have a friend that had her surgery last year, and she said the only test/study she needed was a sleep study. She was shocked to find out that she had a mild case of Sleep Apnea. Her surgery was approved within 2 weeks of the results being sent to insurance.. I meet with my pcp on the 18th at which time I am going to request a sleep study just to see if there are any other issues I am dealing with "plus it will be taken care of if insurance request one". As of right now I am constantly tired, and have not gotten a good nights rest in a very long time. He wanted me to under go a sleep study 2 years ago, but my son was a year old at the time and I was the care taker at night when he would wake up.. Now he sleeps through the night and I feel better about sleeping away from them over night.

[glassido2458 0]

my surgery is 10/8 and aetna approved me in 1 week. Had carefirst during my 6 month documentation and then my job switched insurance companies but Aetna again in 1 week approved me.

[MommyTawnie 3]

my surgery is 10/8 and aetna approved me in 1 week. Had carefirst during my 6 month documentation and then my job switched insurance companies but Aetna again in 1 week approved me.

Oh WOW 1 week and that's after switching insurance companies.. Gives me more hope then anyone will ever know.. I am excited for the 18th to get here.. Then I am down to 1 month left on my 6 months journey leading up to surgery.. I am smiling inside and telling myself everything is going to work out..

[bearwitme 1]

I have Atna also but HMO. Which Aetna do you have. The Group that I am going with told me every thing that was required of Aetna to have this approved. They told me the options that Aetna had and I went with the 3 months of the Nutritionist and the exercise therapist. I actuall went to 1 class a month for 2 hours. 1 hour with the Nut and 1 hr with the ET. I have completed all the requirements and started my Optifast today surgery on the 19 of Oct. I guess what I am trying to say is that why didn't the Docs office tell you were the requirements were. I am glad I went to a one stop shop. Ask them alot of questions about what you will have to do before and after surgery. It took only 1 week for Aetna to approve my procedure.

Hello all I am Tayna. I am a 26 year old mother of 2. I stand 5'3 and weigh in at 237 right now. My BMI is at 42 1/2 is what the nurse told me yesterday. I started my journey back in June for a 3 month weigh in. Only to find out at the end of the 3 months I was suppose to be seeing an exercise therapist as well as a dietician for the 3 months charting if I was doing it that way. Knowing that I would have to start over if I wanted to do the 3 months I went ahead and decided to do the 6 months of consecutive charting. I have 2 months left and I am feeling more more stressed over the whole thing. My biggest fear is being denied for the surgery through insurance. I don't have the money to pay for surgery out of pocket, and insurance covers at 80% leaving hubby and I paying the other 20% which is more in a price range we can afford. I have done my pych evaluation and just had my meeting with the dietician yesterday. The only thing I have left is these last 2 months. Out of experience did you have problems with your insurance approving for surgery, or did it go pretty quickly?? :thumbup::confused::confused:

[karenbarb 0]

Hello all I am Tayna. I am a 26 year old mother of 2. I stand 5'3 and weigh in at 237 right now. My BMI is at 42 1/2 is what the nurse told me yesterday. I started my journey back in June for a 3 month weigh in. Only to find out at the end of the 3 months I was suppose to be seeing an exercise therapist as well as a dietician for the 3 months charting if I was doing it that way. Knowing that I would have to start over if I wanted to do the 3 months I went ahead and decided to do the 6 months of consecutive charting. I have 2 months left and I am feeling more more stressed over the whole thing. My biggest fear is being denied for the surgery through insurance. I don't have the money to pay for surgery out of pocket, and insurance covers at 80% leaving hubby and I paying the other 20% which is more in a price range we can afford. I have done my pych evaluation and just had my meeting with the dietician yesterday. The only thing I have left is these last 2 months. Out of experience did you have problems with your insurance approving for surgery, or did it go pretty quickly?? :thumbup::confused::confused:

hi there,,,,, i had aetna and they ended up paying for most of my band.... i think i had to pay 300 dollars.... now i am looking to revise from the band to the sleeve, so i hope they are aprroving revisions ???? good luck to you

[karenbarb 0]

hi there,,,,, i had aetna and they ended up paying for most of my band.... i think i had to pay 300 dollars.... now i am looking to revise from the band to the sleeve, so i hope they are aprroving revisions ???? good luck to you

hi guys,,,,,,, aetna is what i have as well, and i spoke with the ins. coordinator on thursday of this past week, and i will see the surgeon on thurs to talk about a revision..... so anyway the coordinator said that yes, aetna will approve my band to sleeve revision

[karenbarb 0]

hi guys,,,,,,, aetna is what i have as well, and i spoke with the ins. coordinator on thursday of this past week, and i will see the surgeon on thurs to talk about a revision..... so anyway the coordinator said that yes, aetna will approve my band to sleeve revision

holy crap,,,,, i was approved for a revision in one day !!!!!

[6kiddos 18]

I was approved (I just found out! I had to call...was approved last thursday!) Anyway, they only approved it for outpatient?? Anyone else? :huh: