Your Aetna experience?

[miss meliss 0]

NeNe! Wow 20lbs already?! I know that the first month is a healing process blah, blah, blah.... but I hope to lose weight from day one. Girl, I would be very happy to do 1/2 as good as you! You are off to a great start, way to go!!

Edited April 28, 2008 by miss meliss

[Flowerpurr 0]

Does anyone know if Aetna will pay for an Upper GI? My Dr. wants me to have one done before he will perform lapband surgery. I hardly ever get acid refulux so I see this a pointless.

[amy123 0]

aghhh... everything was moving very rapidly and fast... i have an appt. with my surgeon and he wants my past year of medical records. My appt is this coming Monday but my PCP's med records says it could take up to 2 weeks to get everything faxed. I asked if there was a way i could get them sooner even if i have to pay and they said they will see what they can do. I am afraid ill end up having to reschedule my appointment. Anyone had this dilemma?:blushing:

[Dandy Andi 0]

I've read a lot of your posts and felt the need to chime in. I have Aetna POS.

I submitted my paperwork on 12/17/07 and was approved on 12/24/07. My surgery date was 2/4/08.

I was fortunate enough to have a really persistant insurance claims person at my surgeon's office (Dr. Nick Nicholson-Dallas). She called them daily to find out a status.

Here's a tidbit for those of you that haven't submitted yet... I was told that your submission gets priority if you send it FedEx. That way, there is evidence as to when it was signed for. I simply picked up my package from the doctor's office and mailed it myself.

I don't know that's what did the trick... but something worked well. Good luck everyone!! It hasn't been the easiest thing in the world, but I have 30 less lbs to carry around and that's awesome.

[Dandy Andi 0]

Hi Flowerpurr...

Aetna covered 2 upper GI's... one pre-op and one post-op. I'll likely be getting another tomorrow, so I'm sure they'll cover that one, too.

They're looking for abnormalities in your esophagus and stomach. Also looking for hernias that may need to be fixed.

[Flowerpurr 0]

Hi Dandy Andy,

Thank you for the information. I have a couple of questions for you.

1. Did you do the three or six month diet?

2. If you did the three months did you have to prove you did six in total?

3. What address did you send it to? I may do the same since I was going to submit on Friday.

Congrats on the weight loss. I to have taken off over 30lbs but on an all Protein diet. I need the band before I start putting weight back on.

[amy123 0]

Miss Meliss... congrats on your approval!! You must be so excited... How long did it take you from the time your paperwork was submitted to actually get approved. I got my med records today for my surgeon and my appt is on Monday... Im hoping things go smooth and i start my 3 mo pre-op diet right away. Im ready. It feels like its all so far away but ive been big this long i can make it for awhile longer lol :biggrin:. Anybody know if it all just kinda goes fast from here on out??:thumbup:

[Dandy Andi 0]

Hi Flowerpurr,

I only had to do a 3 month diet. In addition to that, I did nutritional counseling and a psych evaluation (which was a hoot). I also had to provide 5 years of medical history to establish long term obesity.

I don't recall the address to which it was overnighted. I'm sure it's specific to your Aetna plan. Just tell the person at your surgeon's offfice who handles the claims, that you'd like to pick up the package and mail it yourself. My office gave the address to me. The were really helpful.

Good luck with it all! I'm thrilled to have lost some weight (32 lbs), but I've struggled getting everything just right. It's certainly not an easy route, but I'm sure it will be worth it to us both in the end.

Take care!

[ait 0]

Hello all

I just joined the forum and this thread has been very helpful and informative. I have Aetna POS and am starting the process for lap band (the information seminar is next week.) I am now nervous though b/c my BMI fell below 35 (to 33) at one point in the past two years. I gained back all the weight I'd lost then and my BMI is back to 41, but now I'm concerned that I can't be approved and then what is the point of me doing all the legwork? Does anyone know if it's possible to be approved even with BMI dipping below 35? What if my doctor doesn't send them that page from my records?

[miss meliss 0]

When they required 5 years history I had dipped below 35 bmi (34 still very close). I told my doctor that to lose that weight I had to eat hamburger meat and bacon for 3 months (Adkins diet). That I could not eat like that for the rest of my life and when I went back to eating regular food, the weigth came right back. That is the reason I want the band because doing a crazy diet does not work in the long run, I need perment help! They told me I would probably need to write a letter explain how I lost the weight and how rapidly the weight returned. Ask your doctor about this option.

Edited May 1, 2008 by miss meliss
misspelled words

[ait 0]

Thanks, will do.

I just reread my company's insurance plan documents and it says that bariatric surgery isn't covered. I'm pretty pissed - I have a meeting set up with our benefits person to make sure that's true. If it is I have a big problem.

[miss meliss 0]

Hey Amy123,

I have Aetna POSII. I saw a dietian every 30 days for 3 months. On day 90 I saw her one last time and when I was finished I had an appointment (that day) with the actual surgeon to discuss wether this was what I still wanted and did I understand the proceedure. Two days later they sent my info. to Aetna. unfortunatly it went to the wrong department. It took a week to straighten it out. Once the correct office recieved my papers... I was approved in 2 days! I was given the soonest surgery date with was May 12th. So long story short..... January 8th (first visit).... Surgery May 12th!!!!! :party:

[JDUB0414 0]

Hi All,

Just wanted to update you on my husbands approval. After 6 months of waiting, he finally got approved!!!!

[rosforme 0]

I called Aetna to see if Bariartic surgery or Lap Band was covered by my employers contract and it was NO of course...but the rep suggested I appeal to Aetna for the surgery. My question is do I send in a request wait for the No and then Appeal? Because like most obese people I have not been to the doctor regularly, but I have co morbidities, 40plus BMI and my therapist said she would sign off on Lap band surgery, which surprised me because 2 years ago she was dead set against Gastric Bypass.

I'm stuck now - which way do I go .......I guess I need to see my PCP duh!

[lonestar5212 0]

JDUBO414 - OMG!!! Congratulations!!!!!!!!!!!! I just came on yesterday to look and see if it had happened yet. I am so happy for you guys. You are doing so well since your surgery, I am sure your husband is so anxious to get his journey started too. Good luck.

Yeah!!!!!!!!!!!!!!