Aetna PPO

[Minniegiggl 0]

yeah!!!! i got my answer approved. waited 2 weeks. 1st time around. date is awhile away. aug. 9, but, definitely excited.

[PinkyinForney 0]

I have Aetna PPO and i did the 3month supervision diet plan, also did a sleep study which concluded that I did have sleep apnea. I got approved for the surgery. No problems at all. But what I am having problems with are my fills. Insurance does not want to pay for them. They say that it should be all inclusive, which is ridiculous. So I'm fighting for them to approve the fills, because without the fills, I didn't need the surgery. One without the other is NO good at all!.

[PinkyinForney 0]

I have Aetna PPO and i did the 3month supervision diet plan, also did a sleep study which concluded that I did have sleep apnea. I got approved for the surgery. No problems at all. But what I am having problems with are my fills. Insurance does not want to pay for them. They say that it should be all inclusive, which is ridiculous. So I'm fighting for them to approve the fills, because without the fills, I didn't need the surgery. One without the other is NO good at all!.

[AnnaB6 1]

Hey so how did everything go? How do you feel

[PinkyinForney 0]

It's been great!

I had my second fill on Thursday, and I can definitely tell the difference.

I just have issues with the insurance company not wanting to pay for the fills. They are $150 each time.

[Minniegiggl 0]

Let me ask, what state do u live in? I was told fills are covered under the insurance.

[eagertolose 0]

Hi JeeJee...your profile sounds exactly like mine. I, too, have Aetna PPO. I'm 42 years old, BMI is 38, extremely high blood pressure (average is around 180/100 even with medicine), GERD, left ventricular hypertrophy and some kind of heel pain that's apparently associated w/ my weight, according to my PCP. I've been denied once already because the surgery wasn't 'medically necessary'. I continue to jump thru the hoops: just finished my 3 months w/ nutrionist, saw 2 psychiatrists, physical therapist, endoscopy, meeting w/ my PCP every month, and medically cleared by my cardiologist. Tomorrow I have my sleep study. Supposedly, after I had my last nutrition appt. the surgeon's office sent in my paperwork again to Aetna. That was 1.5 weeks ago - I still haven't heard anything. I have alot of people praying for me. I have 2 small children...I don't want to stroke out!

I wish you the best of luck...please keep in touch!

[PinkyinForney 0]

I live in Texas. I too, was told that the fills are covered and now it's this big controversy. But I have my HR dept here at work assisting me in the process and hopefully they will get to the bottom of all the crap.

I will keep you posted in what the status is. I am becoming well educated in this process and want to help anyone else with the same scenario.

[JDUB0414 0]

I too have Aetna, but my requirements are 6 months of a PCP supervised diet or 3 months of a multidisciplanary plan at a hospital setting. I cant do the 3 months because its way too expensive and most are Meal Replacement plans.

My question is do you think If my dr. submits my weight history and a letter explaining why she thinks I'm a good candidate for the lapband, along with my 3 months of visits with the recommended nutritionist will work?

thanks,

Jo

[mbdavis24 0]

I didn't have a problem with AETNA Insurance I was approved in a week and had my surgery the next. I have sleep apnea, thyroid problem, menopause, and been on a diet for 5 years before I heard of this lapband surgery. I had my surgery on May 30. I feel great and still a little swollen. Been taking it easy and watching everything I eat. I hope all turns out well for you and you get to have this done. Insurance who do they think they are. We pay so why don't they do this one thing for us. I haven't received any part of my bill yet but they pay 90% on my insurance. GOOD LUCK!!!!! Hang in there.

[PinkyinForney 0]

I was just told by my HR dept here at work that they are going to cover my fills:clap2:, but they want me to go to the location where i had my original surgery which is an hour and half away. I find that very ridiculous since I live in the DFW area there has to be a in network facility somewhere closer. So we are researching that right now!

Aetna never gave me a problem with approving the surgery, because I had sleep apnea.

I'm doing much better since my second fill. This surgery is really going to work.

I would do it over again and again.

[mbdavis24 0]

I drive 2 hours to my doctors office and I wouldn't have it any other way. I know what to exspect from him and I wouldn't just go to someone else every doctor is different. So watch yourself on visiting another doctor.

[Teal 0]

My insurance paid for the 3 months of visits with the nutritionist and with the counselor/shrink/behavior modification specialist. I did not even have to pay my co-pay with the nutritionist but with the counselor I had to pay my $30 co-pay, $90 total so that was'n't too bad. The excercise part is what cost the most, $760 for 3 months with a personal trainer, and it would have cost me more if I hadn't cut the visits to 30 minutes each (three times per week) OUCH, so there goes my Vegas vacation this year :-( ............. oh well it's for a good cause and Vegas will still be there next year when I am healthier and trimmer :-)

[Minniegiggl 0]

Hi,

I'm surprised they accepted it on the first run. I was worried.

because I don't have alot of xtra money to go into new programs... or

anything like that. I have gone thru almost every dieting program. also,

done a personal trainer 2ce. I dont' know what makes 1 person more

acceptable than another.

Minnie:)

[eagertolose 0]

How were you notified of approval? Did you get a phone call from the insurance company or doctor's office...or did you get a letter?