Aetna new requirements

[aiross 1]

Hi all—anyone recently approved/rejected by Aetna? just wanna know about any challenges since they changed their requirements in may.

new 2020 aetna reqs

[Maryeuh 55]

I was approved. Just needed 4 months with nutritionist with 1 pound of weight loss. I started in Jan. So I don't know if I was grandfathered in or not. It was really easy to get approved with Aetna for me. No crazy hoops to jump through. Just needed a psych eval that I did online. A scan of my gallbladder and and H. Pylori test, that was it.

[aiross 1]

good to know. my surgeon’s office submitted for approval today so now the real wait begins... thanks for sharing!

[Nthomas404 0]

I currently have Aetna as well. Just started my journey last month and I'm required to have six months of visits. I'm hoping i can have the surgery before year end since I have already met my deductible and out of pocket for the year.

[aiross 1]

Hi. I was just approved by aetna. 6 months is not required. Please make sure your surgeons office is aware of the new requirements, as mine was not until I told them. they only require 12 sessions between a program (i did weight watchers virtual group sessions), your nutrionist and surgeon appts and preop testing/clearances. i was able to complete and submit to aetna in only 6 weeks. good luck!

[Chris1345 19]

Keep in mind, you can be with the same insurance company as someone and have different requirements. A lot of depends on your group plan, especially if you’re on employer insurance. For example, I have Kaiser and its not covered at all. Others have Kaiser with different plans and it’s covered.

[aiross 1]

That has to do with coverage, as in if your employer purchased the rider for wls. If it is covered, each insurance company is likely to have 1 set of standards to review candidates by. that is whar is reflected in the aetna clinical bulletins, for example. While not all aetna plans have wls coverage, the ones that do are guided by the same set of aetna requirements (in the bulletins).

[LillyDex 0]

Hello, (Im new) I have Aetna, I started my journey to surgery in Dec.2019. However denied my gastric sleeve surgery even though my BMI is 51 and Im pre diabetic and asthmatic. They also denied my first appeal.

Getting ready to request the peer-to-peer meeting with my surgeon and and Aetna. Any thoughts, ideas, comments are appreciated as im really feeling hopeless now.