Finally - Aetna Has Approved My Surgery!

[RKidder 0]

After 2 previous "tentative" surgery dates, I have been approved! Surgery date of May 23rd!!

Advice to some of you with difficulty getting insurance approval: Sometimes it is the surgeon's office staff that don't submit appropriate paperwork in a timely fashion. Call and follow-up -- regularly. I found out that my denial letter sat for 2 weeks in the surgeon's office and Aetna had requested a Peer to Peer Review within 14 days of receipt of the first denial letter, and nothing had been done. Secretary was out on vacation for a week and the second week, she did not act on it -- even after several phone calls from me. So, my May 2nd surgery date was cancelled.

At this time, I would be hard-pressed to recommend this surgeon's office for lapband surgery, unless someone would be "self-pay". The office staff evidently are inept at handling insurance matters...

Rachel

[edieparks 2]

Rachel,

Good advice and congratulations on you band date.

I,m here for you and any questions .

Good luck,

edie:)

[juliegeraci 7]

Rachel, congrats on getting your insurance approval. Good luck with your surgery. Julie

[Billie Elaine 0]

I've just started the process. I had looked up Aetna's qualifications for Lap-band and got together my five years of medical records, got the psychiatrist thing done, seen the psysiologist, nutritionist and now have an appointment on the 24th of April with the Lap-band doctor. Is Aetna a hard nose in getting this surgery done?

[RKidder 0]

Billie,

It is dependent on your employer. Sometimes the employer has an exclusion in the policy. Check with your employer's human resource department/benefits dept. and start there. Ask if Lap Band surgery is a covered procedure. Also, Aetna has a weight loss surgery policy bulletin. This is available by contacting them or you can see the bulletin online by going to Aetna.com. I made a copy of the policy and provided a copy for my surgeon's office. I highlighted the specific areas of the policy that pertained to me. Even then, I did not find out until later that Aetna requires 5 years of documented weights; 3 months of consecutive visits with your primary care provider with documentation that those visits included discussion of weight loss efforts, exercise efforts, and letters of medical necessity from the primary care provider. Aetna does not exactly provide you with a "checklist". I found Aetna to be evasive when called and asked about specific requirements to be met. Nevertheless, I was woman "on a mission" and would not give up - I think insurance companies make it difficult so one will give up and not pursue it.

Good luck - let me know if I can help in any way.

Rachel

[AnnaB6 1]

Billie,

It is dependent on your employer. Sometimes the employer has an exclusion in the policy. Check with your employer's human resource department/benefits dept. and start there. Ask if Lap Band surgery is a covered procedure. Also, Aetna has a weight loss surgery policy bulletin. This is available by contacting them or you can see the bulletin online by going to Aetna.com. I made a copy of the policy and provided a copy for my surgeon's office. I highlighted the specific areas of the policy that pertained to me. Even then, I did not find out until later that Aetna requires 5 years of documented weights; 3 months of consecutive visits with your primary care provider with documentation that those visits included discussion of weight loss efforts, exercise efforts, and letters of medical necessity from the primary care provider. Aetna does not exactly provide you with a "checklist". I found Aetna to be evasive when called and asked about specific requirements to be met. Nevertheless, I was woman "on a mission" and would not give up - I think insurance companies make it difficult so one will give up and not pursue it.

Good luck - let me know if I can help in any way.

Rachel

Ok so when you say 3 month with your doctor thats with the surgeons office correct? I have not followed with my family doctor only because she doen't really believe in the lap band, but then she isn't overwieght.

[Billie Elaine 0]

Somehow, I knew that Aetna required five years medical records, and I already had that together before ever seeing my doctor along with signing up for an Aetna approved 90 day weight loss program. Aetna also requires a psychiatric visit and tests, which I did through an approved Aetna plan psychiatrist. I'm going for my echocardiogram on May 7th! Everything is moving closer toward the day of surgery, but I think it'll be toward the end of June to beginning of July. I'm already changing my eating habits and attempting to exercise as much as possible despite my physical limitations. And thanks so much for the support - it means so much to me!

[passiton 0]

Aetna denied my claim because while on the 6 month weight main. thingy my BMI went lower than 40, 39.8 to be exact. So, now I am using Walter Lindstrom with obesitylaw.com. It has taken longer than I thought, but I am hoping everything will turn out o.k.

[jeejee 0]

Hi Passiton!

Did you have any co-morbidities with your BMI. I know that they would prefer a BMI of 40, but they willl approve your surgery if you have the required comorbidities. Hopefully your appeal turns out positive. Please keep me posted. My BMI is 38 and I have sleep apnea, Asthma,Acide reflux, etc... now I'm worried. I have Aetna EPO.