Excited Waiting For Gastric Sleeve Surgery Insurance Approval

[mouse trap 5]

so im done with the the 3 months of doctor/ nutritionist / psych visits ., had a sleep study an upper endoscopy and many other tests. I spoke with the obesity center and they said that they will submit for approval from my insurance in the next few days.. Im a little concern with getting this approved for my bmi is hovering right above 40 - 41 and have very few health issues other than high triglycerides and acid reflux.., My insurance is thru aetna .. Any one here had any issues getting approved through aetna ? .. Well wish me luck..

[longer-life 139]

Hi there,

I have Aetna as well and my paperwork should be submitted today. My BMI was 40 (now 39) with no comorbities but I have not been that weight for the last 2 years. I lost some weight on Weight Watchers last year so that counts against me. However I had a sleep study last month and I have severe sleep apnea. So weird to be happy about that, but I am. So now I am required a 35 BMI, not 40 anymore.

Were you able to prove you have been over 40 BMI for the last two years? What were the results of your sleep study? Is high triglycerides one of the comorbities they list? I forgot them all. I know Diabetes is another one.

My approval is not a sure thing either. One never knows what they can come up with. Best of luck to both of us!

[mouse trap 5]

I have an appointment for the sleep study results in 2 weeks.., They said its a lot of data and they need about 4 weeks after the study for a result., My Pcp told me that the triglyceride are a comorbities... I have my fingers crossed.. wishing u d best aswell

[Tenna38 17]

I have BCBS Federal and I too am waiting on approval. Unfortunately but fortunately I have (2) qualifying conditions sleep apnea and hypertension. Hopefully my approval will just be a formality. Good luck to you all!

[happy1957 138]

I too have Aetna... My BMI was right at 40, I was denied because I lost weight in 2009 and fell below the 40 BMI, my co-morbidities are high cholesterol/ high blood pressure/ and reflux, which are not considered true co-morbidities to Aetna. I am appealing the decision based on prior weights of 40 BMI's in 2007 and 2008, but that one low year, although it is close to 24 months., still isn't the 24 consecutive months needed. My experience has been nothing but negative with Aetna, from lost documents, to miss filed documents to lack of returned phone calls etc. They are hoping I go away. If I am denied this time. I will go direct to the the state Insurance commission to file the next appeal. I hope your experience is better..Never give up!!

[longer-life 139]

I have an appointment for the sleep study results in 2 weeks.., They said its a lot of data and they need about 4 weeks after the study for a result., My Pcp told me that the triglyceride are a comorbities.

I was given the results of my sleep study in 1 week. It is a shame they take so long at your place. Also, I suggest you read Aetnas "Clinical Policy Bulletin". It lists EXACTLY what Aetna will cover. I would not rely on PCPs. They are usually not familiar with insurance coverage. The bulletin is found on "myaetna.com". I called Aetna and a customer service rep. helped me find it. Then the insurance coordinator at my surgeons office confirmed it.

Best wishes!!!!!!

[longer-life 139]

My experience has been nothing but negative with Aetna, from lost documents, to miss filed documents to lack of returned phone calls etc.

I am sorry to hear this. I got approved today in less than 72 hours! Best of luck. I hope it all turns out ok for you.

[mouse trap 5]

Nuthing yet on my side.. but congrats

[Jodi G 3]

Hi this is my first post....I too just finished my last weigh in with my doctor so the surgeons office said they will now submit to the insurance and I am anxiously awaiting approval also.

I wish you luck.

[longer-life 139]

Nuthing yet on my side.. but congrats

I hope it all turns out ok for you too. Best of luck. Please keep us updated.

[bjstrans4mation 21]

My paperwork was submitted to Aetna 11/18. I've called every day since then. Today the rep put me on hold and contacted the authorization department. They just said all info had been received and needed to be reviewed. I'm praying for an approval MONDAY if not by the end of the day today!! We must remain focused and positive--Blessings2u--BJ

[Living again 11/17/2011 40]

so im done with the the 3 months of doctor/ nutritionist / psych visits ., had a sleep study an upper endoscopy and many other tests. I spoke with the obesity center and they said that they will submit for approval from my insurance in the next few days.. Im a little concern with getting this approved for my bmi is hovering right above 40 - 41 and have very few health issues other than high triglycerides and acid reflux.., My insurance is thru aetna .. Any one here had any issues getting approved through aetna ? .. Well wish me luck..

g

[Living again 11/17/2011 40]

Good Luck Me too I have UHC Empire have 39 bmi newly dx hypertension and acid reflux borderline diabetes osteoarthritis knees ankles and severe arthritis back so I am praying had everything done!

DArn it its empire bc bs the hospital portion lol oh jez hope its easy!

[bjstrans4mation 21]

my BMI is 54, highest weight 354---current weight 318----diagnosed with sleep apnea and my numbers are borderline diabetic. I totally understand the knees, back and heel spurs just to name a few. I have also been unable to conceive and that's the most crushing thing of all. We need this and we shall have this.

Blessings2u---BJ

[Laura2112 4]

I am waiting too! ugh. I sent over all my paperwork to the Dr. office on 10/18. I called Highmark BCBS today and they didn't have anything yet. ::sigh::