Aetna Insurance

[Kay2016 2]

Does anyone have any personal experience with Aetna approving wls. (Good or bad experiences welcomed just really interested in what I have to look forward to with them)

I talk with a dietician and I think nurse practitioner. Did my weigh in & all. My bmi was 39 Aetna requires it to be 40+ or 35 with other health issues(they listed 3 things they considered serious) well I have a health condition that's not listed not sure what I'll have to deal with. Or if this officially disqualifies me. The nurse practitioner acted as if it didn't. Just a bit confused. I'm a student can't afford to do self pay at the moment. Any suggestions. A bit new to this.

[Indygirl1 14]

Aetna was the worst. I was denied two times. The third time I was approved.

[jj7481 363]

Aetna was who we had before our employer switched to BCBS. Their requirements were about the same as BCBS, but our employer had pretty specific requirements to begin with.

Ask questions of your surgical team. Call Aetna direct and convey your concerns to see if you would qualify for a provisional approval. Outside of that your surgical team has someone who works with insurance companies EVERY DAY. Try to get ahold of them and ask their experience with Aetna and if they think you would be approved or rejected.

It is better to front load the process rather than wait 3-6 mos only to find you aren't covered.

[Kay2016 2]

Thanks. & I talked with the nurse practitioner. She had said Aetna is the worse as well. Someone got denied while prepping for surgery because while on the 2 week liquid diet they lost one pound. Smh

[Indygirl1 14]

That would be me. Aetna told me that I had to lose 10 pounds before surgery and I only lost nine. I went through a lot with Aetna but I thank God I had my surgery on 12/4/15 and thus far it's going well. I'm down 40 pounds.

[cadladykim 55]

My only problem with Aetna was they had a "maximum lifetime benefit amount" that they would pay for. That amount wasn't known to me until after surgery. So even after a year, I'm still battling with them and the hospital to figure out the correct amount I need to pay out of pocket... $10k or $25k!! It's a mess!

My mistake is that I didnt call Aetna personally to find out all the particulars, I relied on the doctors office to tell me what I though I needed to know. It turns out all they cared about was if it was covered, not anything else. My doc office said had they of known there was a max amount I could have negotiated some rates with some of the doctors and hospital before hand.

Edited February 15, 2016 by cadladykim

[jj7481 363]

That's the double edged sword. I'm glad my surgical center was up front about things and guided me every step of the way.

Nevertheless, if you call Aetna direct they will tell you the specific requirements for your insurance policy.

[Kay2016 2]

Thanks for the replies and details truly appreciated. Wish you all well on your weight loss journey. =)

[dede0314 356]

I had a hard time with Aetna as well, but I guess in the end it was my fault. I gained weight during the 3 month process and got denied and had to go through their external review appeal process which I ended up winning.

Hopefully your process will go smooth. Good luck!

[tamartaya1 3]

Anetna was good with my approval but at the end of everything I owe 12000 dollars for the surgery, while all my medicaid buddies 0.

Sent from my SM-N910T using BariatricPal

[dede0314 356]

@@tamartaya1 WOW! If you don't mind me asking why did you owe so much out of pocket?

[Kay2016 2]

12k for what?