Aetna ***

[Luckysgirl1909 2]

Hi everyone.... Im new. My name is Jennifer and i have started my whole list of doctors appointments for surgery. My surgery date is June 10th and I am sooo excited.

I have an issue though and I'm soooo nervous I wont be approved. It appears I am 36 on the BMI chart. I am 5'7 and 234. 110 it says overweight for my height . I am going through a great doctor in NJ who I hear rave reviews about but, for starters I was crossing my fingers I had sleep apnea lol cause that could have been my comorbidity for approval but, turns out I am a 5 I still have more docs and tests to do but, wanted to know if anyone else had Aetna hmo in NJ who is similar to me on the scale? Also, if they got approved for surgery with Aetna... i was told they are the hardest to get approval with... I will be so let down if I go threw all of this and thwy shoot me down. Any adivise or anything anyone can give i would love to hear it.... thank you

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[kcavender1973 0]

Do you have diabetes or high bp? These are also comorbidities.

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[67GTONUT 28]

I am in NJ and have Aetna..... All I was told is I have to do the 6 months of monthly required meetings to be qualified and approved..... I am scheduled for 9/12

[Luckysgirl1909 2]

I am in NJ and have Aetna..... All I was told is I have to do the 6 months of monthly required meetings to be qualified and approved..... I am scheduled for 9/12

Wow! 6 months... oh no! Did you call Aetna yourself or did your doctors office take care of it all for you? I see Dr. Sadek again April 28th I guess to go over what my docs have said so far. All I can do is cross my fingers. I am soo ready for this and will be so bummed if they turn me down.

Jennifer

[Luckysgirl1909 2]

Do you have diabetes or high bp? These are also comorbidities.

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I just had all my blood work.. i have a physical on Thursday with my primary.. so i guess they will go over my blood work results etc. I was only a 5 for sleep apnea so as meswed up as this sounds I hope i have something that will qualify me. My husband had his a year ago and granted he made the BMI cut of 40 he still had other issues but, all meds bp etx. Went away already so im mot freaked out if I have high bp or something. Ugh! This is sooo stressful lol

Jennifer

[67GTONUT 28]

My Dr. Took care of it....

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[NWB8 10]

Well hello first off i just wanted to tell my story and how upset i am . Well this is now going more then 6 months more then it was suppose to well i did everything by the book from AETNA and well they denied me for gaining 2lbs mind you i was on my menstrual week my luck so nothing i could do about it i was mad but then they told my advocate that i can start from my highest weight 240 and do 3 months more GREAT!!! right? well whatever i completed it on March 18th 2016 and weighted 234 i actually lost some weight and then when i left my doctors office with a positive mind and happy with my surgery date and the day to pick up my shakes and go for my clinical clearance, two hours later i get a call from my advocate saying that he called aetna to submit my papers and AETNA told him that since i was DENIED on Jan of 2016 I HAVE TO WAITE 6 MORE MONTHS TO SUBMIT MY PAPERS AGAIN!!!! Really i was soooo mad soooo mad and well here i am at lost i live in FL i just need to know the TRUTH i called AETNA and can you belive they didn't have answer for me that they will call me back well it's been two weeks now and NO ONE HAS CALLED ME.

[Luckysgirl1909 2]

Well hello first off i just wanted to tell my story and how upset i am . Well this is now going more then 6 months more then it was suppose to well i did everything by the book from AETNA and well they denied me for gaining 2lbs mind you i was on my menstrual week my luck so nothing i could do about it i was mad but then they told my advocate that i can start from my highest weight 240 and do 3 months more GREAT!!! right? well whatever i completed it on March 18th 2016 and weighted 234 i actually lost some weight and then when i left my doctors office with a positive mind and happy with my surgery date and the day to pick up my shakes and go for my clinical clearance, two hours later i get a call from my advocate saying that he called aetna to submit my papers and AETNA told him that since i was DENIED on Jan of 2016 I HAVE TO WAITE 6 MORE MONTHS TO SUBMIT MY PAPERS AGAIN!!!! Really i was soooo mad soooo mad and well here i am at lost i live in FL i just need to know the TRUTH i called AETNA and can you belive they didn't have answer for me that they will call me back well it's been two weeks now and NO ONE HAS CALLED ME.

Omg! That is horrible... i am soo sorry for what you are going threw. I could only imagine how mad you are. I know I am trying to stay positive and do all is asked of me but, I am scared to find out if I get approved or not. Went to cardiologist today and shes like wow yoyr heart rate is really up today... Im like yeah... I have AETNA and if you dont cone up with a co morbidity for me my surgery is out the window i was like you would be stressed too of you were me! Ugh!

Do you have a secondary ins maybe that can help?

Jennifer

[izzy13 117]

Check your policy regarding co morbitities really carefully! My bmi is 35.2 so I just make the 35 cutoff and I have high blood pressure and mild sleep apnea. My insurance denied me bc the policy says blood pressure only qualifies if I were to take 3 meds or more and sleep apnea only qualifies if it's severe. They are making it more and more difficult, my bp always sucks but I only take one med bc that's all I can afford and side effects suck!!!!

[Luckysgirl1909 2]

Check your policy regarding co morbitities really carefully! My bmi is 35.2 so I just make the 35 cutoff and I have high blood pressure and mild sleep apnea. My insurance denied me bc the policy says blood pressure only qualifies if I were to take 3 meds or more and sleep apnea only qualifies if it's severe. They are making it more and more difficult, my bp always sucks but I only take one med bc that's all I can afford and side effects suck!!!!

Jesus! I read what aetna put on there website for NJ and it doesnt say any little fine print things like that. My surgen said once all my tests are done they will call Aetna for me and submit all my paperwork to them. They seemed pretty confident that they will make it happen but when I go back on the 28th im going to show him what i have so far. My docs office did give us this one paper in our packets to have the doc sign off on saying they have monitered me an diets for 3 or more konths and then why do they think we should be approved. So my doc put sleep apnea with no number, high cholesterol, early age of heart disease cause my dad passed away of a massive heart attack at 38 .. same age as me now etc. I am praying that will be enough but, I stil have to do my stress test and ecko too so ya never know what else they will find. All i can do is pray lol

Jennifer

[josiek1988 70]

I am in ohio and I have Aetna as well. I am doing a band to Sleeve revision because of complications. When I met with the Nutritionist I asked her if she knew how Aetna was. Her exact words were, "they are difficult at best" I am a month into the 3 month required supervised weight loss. I don't have to actually loose any weight I just can't gain an ounce. I am really nervous about being denied.

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[NWB8 10]

• Luckysgirl1909

it's not easy it stresses me out and stress and me do not get along there are times i can handle it buuuuut there are days where i get into bad moods because i feel like they don't want to help me and that makes me mad. But no i don't have a second INS I have Aetna thru my job. I really hope you get approved and well i just finished writing my first appeal letter i'm ready to fit this.

[papoose 48]

I have Aetna and have had no problem. I had the lapband in 2016. I had it removed in 2014. I had the sleeve in 2014. And in January 2016 just had a revision on my sleeve. I only did the 6 months in 2010 with the lapband. My doctor is in New Jersey. Once my paperwork was submitted for each surgery I got my response within 24 hours. And no extra money out of pocket. Just my co-pays.

[Luckysgirl1909 2]

I have Aetna and have had no problem. I had the lapband in 2016. I had it removed in 2014. I had the sleeve in 2014. And in January 2016 just had a revision on my sleeve. I only did the 6 months in 2010 with the lapband. My doctor is in New Jersey. Once my paperwork was submitted for each surgery I got my response within 24 hours. And no extra money out of pocket. Just my co-pays.

Omg thats amazing! Im at the tail end of all my doc appts for approval... crossing my fingers with each visit lol

Jennifer

[dede0314 356]

Well hello first off i just wanted to tell my story and how upset i am . Well this is now going more then 6 months more then it was suppose to well i did everything by the book from AETNA and well they denied me for gaining 2lbs mind you i was on my menstrual week my luck so nothing i could do about it i was mad but then they told my advocate that i can start from my highest weight 240 and do 3 months more GREAT!!! right? well whatever i completed it on March 18th 2016 and weighted 234 i actually lost some weight and then when i left my doctors office with a positive mind and happy with my surgery date and the day to pick up my shakes and go for my clinical clearance, two hours later i get a call from my advocate saying that he called aetna to submit my papers and AETNA told him that since i was DENIED on Jan of 2016 I HAVE TO WAITE 6 MORE MONTHS TO SUBMIT MY PAPERS AGAIN!!!! Really i was soooo mad soooo mad and well here i am at lost i live in FL i just need to know the TRUTH i called AETNA and can you belive they didn't have answer for me that they will call me back well it's been two weeks now and NO ONE HAS CALLED ME.

I had same issue. Did 3 month program gained weight got denied. Aetna said I could do 3 more months and if I lost the weight I would be approved. Did 3 more months lost 20 pounds and they still denied me, but they didn't say anything about doing 6 more months. I went through the appeal process and went through an external review where Aetna's decision was overturned. Aetna can be very difficult to deal with but don't give up that's what they want.