Anyone have Meritain Insurance?

[hillsister_03 0]

Does anyone here have Meritain Insurance? It’s an Aetna company. Not sure what the requirements are. I completed everything my surgeons office said that was required but I’d like some more input. Also I have 6 months of weigh ins from 2021 that are consecutive and 6 months of weigh ins from 2023 that are not. Will I still be approved? I also have two PCP letters.

[ChunkCat 732]

It is hard to say without seeing your specific policy details and talking to your insurance company. Even policies from the same company can vary dramatically... Your surgeon's office will know what your insurance requires and if it gets kicked back usually it is because a code is wrong or a paper isn't filled out properly and once remedied approval is then given. If the surgeon's office is preparing to submit to insurance or has already submitted your case to insurance, they must feel you've met the requirements given to them by the company. It is a waiting game after that!

Edited January 28, 2024 by ChunkCat

[Kayparish24 0]

I have meritain and of course my doctors office checked to make sure I had coverage. They gave them a list of pre surgery procedures I would have to do such as ultrasound, endoscopy, nutrition classes, psych evaluation among other things prior to surgery, which I have done and has cost me almost 3 thousand dollars out of pocket to do. Now they denying me saying I’m not covered because obesity is not covered on my insurance plan, but the doctor offered called prior ( 8 months ago ) to make sure. When I call meritain they told me to have them remove the code that means “obesity” and resubmit documents and it should be approved. My doctor office is saying there is no way to do that. I am highly disappointed and upset to have spent so much money and hopes for a surgery that was CHECKED prior to doing all of these other procedures just to be denied now that it’s time to schedule. Anyone with any knowledge , experience or advice on this? And how to get it approved with my insurance??