general insurance questions

[JaneyB 28]

So I finally asked my Dr. for support in getting sleeved and she is behind it 100%.

I am awaiting a packet from my insurance co (aetna) on what the process is etc.

So how long typically is the process? The patient coordinator said that my first step would be to go to a seminar at the place I would be getting sleeved. Then there are all these requirements - counseling, tests, nutrition guidance, Dr. visits, etc. I guess there is usually a 3 month program or a 6 month program before you can get the sleeve.

So are all of these requirements BEFORE you get approved? Or do you get approved to do these requirments and if you complete them, you get the surgery? Does insurance pay for these requirements?

What about the "diets you've tried and failed?" I haven't been on a bunch of diets, just Weight Watchers.

My Dr. hasn't done very many of these referrals and she said that insurance companies are all different which I understand but is there any general information anyone can give me?

Do you have to go to the surgical site often? I am about 3 hours away and hopefully it won't be often because that would be serious $$ as I live on an island.

Thanks for any help or guidance you can give me.

I've been mulling this decision for a long time and now that I have decided I don't want to wait forever.

[mentalistfan 189]

You have asked a very common question and you will get different answers because doctors and insurance companies are all different. This is a small list of how mine is going so far...I called and scheduled to attend seminar, the surgeons office sent me information to take to my PCP...I have to see my PCP six straight months, he has to write a letter that he recommends it, blood work, EKG, chest x-ray, sleep apnea test...if over 50, which I am not, a stress test, go to a nutrition class, a psych evaluation, see surgeon, but not often...some people get endoscopy, I'm not sure about it yet...I hope this helps

[mentalistfan 189]

You usually get all these tests done and then get approved or not, and most insurances pay for these things leading up to the approval or not, ask you insurance company...most surgeon offices know the answers because they deal with insurances so much.

[JaneyB 28]

Wow, thanks for such quick replies.

I'm worried about jumping through the hoops and paying all the copays for the tests and stuff and then getting denied. I'm worried that the surgery won't be until next year.

[mentalistfan 189]

Your surgeon and their staff will have a good idea if you will get approved. You will have to have a certain BMI and they take into account if your diabetic or have high blood pressure...check with your insurance ASAP

[ashrn80 27]

I have Aetna also. You will have to jump ALL hoops first and then get approved. Aetna doesn't make it as easy as other insurance companies and they even made it a little more difficult as of 1/31/14. Just stay focused and remember it takes a number of months to go thru the process...it will be worth it!

[Casie83 38]

I have Aetna, I only had to do 3 months supervised diet. My surgeon required more than my insurance. But mine was submitted on Friday of last week and was approved on Tuesday! I consider that pretty quick!

[cutiepieinchi 158]

I have bcbs. I have no supervised diet. Before I see my surgeon,I had to go to as cardiologist and pulmonologist. I go to the gastric center tomorrow and psych on April 14th.

[lynn2win 142]

Wow I am still waiting to hear back from Aetna not having faith

[cutiepieinchi 158]

Wow I am still waiting to hear back from Aetna not having faith

Have faith . I hope everything works out for you.

Edited March 27, 2014 by cutiepieinchi

[Get.Waisted 45]

I have BCBS, no supervised diet required. I had to do 1 Nut visit, 1 Psych visit and then the surgeon submitted to the insurance and it took about a week to get my approval. My surgeon also requires that I have an EGD done and now i'm just waiting on my surgery date.

Once you contact your preferred surgeon they will give all the details you need, most likely they will check your eligibility before they even schedule your first consult appointment.

[sleeve30 33]

I have BCBS, no supervised diet required. I had to do 1 Nut visit, 1 Psych visit and then the surgeon submitted to the insurance and it took about a week to get my approval. My surgeon also requires that I have an EGD done and now i'm just waiting on my surgery date. Once you contact your preferred surgeon they will give all the details you need, most likely they will check your eligibility before they even schedule your first consult appointment.

I just hope I get my approval this fast!!!!

[mentalistfan 189]

What's an EDG?

[sleeve30 33]

What's an EDG?

Endoscopy