Aetna 2015 Weight Requirements

[ShrinkingPeach 1,291]

I have Aetna, I had to do an upper GI, blood work, an EKG, a letter from my PCP recommending the surgery, a psych eval and 2 years of pcp notes from visits with at least 6 months of weight loss attempts with 3 of those being consecutive months.

Aetna stated it takes them 2 weeks when all documentation is provided to approve.

Thanks to my surgeon's office it took me 2 and a half months to get approved. They did not follow what Aetna asked for and dropped the ball in a major way!

[kjsweigart 15]

Shrinking peach. There is no longer a 2 year history requirement. How long ago was your approval ? I think That was since last August

[bunnybunny626 10]

Hi! I am new to the group. I just submitted my insurance forms to aetna. I am hoping to get approved. My BMI is 36 and I have sleep apnea. I struggled with my weight since I was 16. Now at 42, I am tired of dieting and not losing. I called insurance today and it still is pending. Did anyone get approved with a borderline BMI and sleep apnea?

[azziew 7]

Wait I think I have that insurance there are only three people that do approve

If united health care then yes

[marybowlus 17]

Well, it's been one week and one day and Aetna still show my paperwork as pending . . . Guess it's time to relax, enjoy the weekend and pray I've got a favorable answer this upcoming week.

[SleevePerry 248]

Mary - here's hoping you hear something on Monday. Fingers crossed!

[handymannynyc1 82]

@@marybowlus I hope you get some good news this week. I have my second appointment with the surgeon on Tuesday. I will ask him how long it take to get approved.

[marybowlus 17]

I have managed to stay busy all weekend but as the work week approaches I find myself thinking about the pending decision with Aetna. Thanks for all of the encouragement! I pray that tomorrow is the day I know one way or the other! Will keep you all posted!

[Bubbletoes 124]

I have Aetna and so far my pre-op journey has been such a pain! I finished with all of the requirements (blood work, sleep study, 4 weight loss appointments at least 30 days apart with the doctor, 2 required psych evaluations with two different psychologists, an EGD, a cardiac stress test, leg ultrasound or Doppler on my legs for blood clots and medical clearance from my cardiologist, pulmonologist and endocrinologist) in April. I have insulin dependent diabetes for 41 years, hypertension and CAD with a stent. My BMI at my first weigh in was 41. My surgeon scheduled me for surgery on May 4th knowing everything they wanted was completed and then sent for approval. Wrong! My last weigh in appointment with my doctor was one day too early, because we calculated wrong because of the short month of February. I had to schedule another appointment for another final weigh-in but could not be scheduled until May 14. My coordinator also told me not to gain an ounce over my original weight or I would not be approved (no problem - I lost 21 lbs which took me down to BMI 38 which was fine). I was rescheduled for surgery on May 20 after my first date was cancelled. Needless to say I've been on pins and needles waiting for approval which finally came this afternoon because my coordinator has been on the phone with them constantly until they gave her an answer. The day after tomorrow is my day! All I can say is make sure every whim your insurance company wishes for is taken care of perfectly! The stress alone with this process is enough to send us all to our local psych ward!

[azziew 7]

@ bubbletoes that is great so insurance has been such pain in the butt

[ASLEEVE4ME2015 23]

Hi everyone!

I'm in the home stretch of the VSG pre-approval process and the worry that Aetna will deny me has started to creep in. I'm getting a bit panicky!

I started the process with a 41 BMI. No co-morbidities.

My 2013 and 2014 BMI was 38 (I was on Diet2Go in 2014 and Nutrisystem in 2013).

I've provided the surgical coordinator with BMI records for 2013 and 2014, but she doesn't believe they are needed. I'm not so sure. More so, I'm worried that not having a 40 BMI in 2014 and 2013 will cost me surgical approval.

Has anyone had experience with Aetna in 2015? Whatever experience you can share would be helpful.

Thanks in advance!

. I have United Healthcare//Oxford & got approved for revision (band to sleeve) BMI is 28. Surgery is May 27th. Got approved in 8days!!!! Yeaaah Boyyyyyyy!!!!!

Edited May 19, 2015 by ASLEEVE4ME2015

[handymannynyc1 82]

Everything got submitted to Aetna today. Once I get approval I need to get medical clearance for surgery then a 2 week all liquid diet. Pray for me people. I hope everything goes smooth.

[marybowlus 17]

Congrats and good luck to you! I'm still waiting to hear from Aetna. My surgeon's office called Friday but when I called today Aetna told me they have until the 21st to make a decision. Praying for patience!

[handymannynyc1 82]

@@marybowlus that's two days away. You will be fine. Good luck and I hope it all works out.

[marybowlus 17]

Approved! Yahoo!!!