Aetna Approved!

[Reductionist 0]

Hello:

Wanted to comment on Aetna. Suprisingly, they have been SUPER responsive and approved me in less than a week. Obviously, one has to have the proper documentation or they will find a way to deny. However, once submitted, they have been agreeable and responsive. It literally only took them 3 days from receipt of all information.

PS-I called every day to check status. Perhaps this is part of the trick.

Best of luck to all

[Flowerpurr 0]

Congratulations...Did you do the three month diet or the six month? I am currently doing the three month but I don't know if I need a total of six months or not.

[elle 1]

I have Aetna POS. I was approved also in what I think was a quick amount of time. I was told by my doctor's office to supply them with 6 months doctor supervised documentation. They tell everyone to get the 6 months documentation because most insurances require it. Aetna does. So if you have all the documentation and you have jumped thru all the hoops, and you are eligible, I think Aetna will approve it. My husband has different insurance and because I am a patient already, the insurance coordinator in the office told me that he doesn't need 6 month documentation for his insurance. We will see if he gets approval quickly. Anyway, good luck.

[Flowerpurr 0]

I am doing the three month diet which is more than just the Dr. supervised diet. It's the presurgical diet. Which costs more and everything. I see the exercise physiligast once a week, the behaivor modifaction specalist once a week, a Dr. once a week, and the dietician once a week. Plus I have weekly group meetings. So I feel that I have done more in the three months than they require for six. So I am hoping that is good enough for them. I don't want to have to wait another three months.

[Reductionist 0]

Hello. I have six months.

[Flowerpurr 0]

I understand that. But why did you do the six instead of the three? There is a choice to do one or the other? Also did you see as many specalists as I am right now?

[elle 1]

The presurgical diet sounds like a lot more effort than the 6 month supervised diet. Hope Aetna approves you. Hope the specialists are helping you too. It should be helpful after you get the band. Good Luck.

[Paula Maglica 0]

I have Atena too, they've made me do the 6 mo diet and have the 5 yr medical history, (to show being overweight) to see the cardic dr. , the pych dr. & the lung guy. All of which I've done so far. The only thing I'm having problems with right now is tracking down my medical records, my old Dr moved about 2/3 yrs ago, and then I moved so everywhere I call thinking that's where they are, they tell me to call somewhere else, I think I've found out the right person who to call which I have done, now I'm sitting back for just a couple of days to give them a call to check the results. This months weigh in is my 5 month, next month will be my 6th and as long as I keep losing the weight, they will then submit all my paperwork and then I'm looking to be banded in June! I can't wait!!!:biggrin:

[Flowerpurr 0]

Dear Mommymj1,

According to Aetna's new rules you only need a two year weight history not five. If you look it up on their website it tells you. Second they say if you do the three month diet you need to see all those Dr.'s. Did you try to apply after three months? Who did you talk and they said you have to do six months? I have read on here people doing three and getting approved. I go every week and see the Dr. and plus I follow up once a month with my PCP. So I am doing double the work. I think Aetna is ver inconsistant on what they require. Here is a link that shows two years. Plus it show three months if you do the pre-surgical diet. I have paid out $1250 for that diet to get it done faster and get approved. They better not deny me.

Obesity Surgery

[miss meliss 0]

I am going to a WLS Doctor. According to my Aetna plan..... 6 months with a Primary Care Dr. or 90 days with a WLS Dr. You need to see a dietian once a month, have a psychogical evaluation and have 2 co-morbidities. I have taken the shorter trip and I hope to turn in my paper work April 14th!! I hope my turn around is as short as yours!!!

Congratulations Reductionist!!!! I really hope my reply goes as fast!

[bjperkins54 0]

I also have Aetna -- I am having to go through a 6 month physician monitored diet plan which I just started a week ago....they say at month 5 they'll start the process to get final approval for the surgery. I am borderline, so if I lose over 13 lbs, I will no longer qualify for the surgery. We'll have to see how it goes I guess.

[sunny8 0]

You don't know how helpful your post has been. I have Aetna and was worried about the 5 yr requirement since my BMI was not high enough all those years. But with the new 2 yr req. I should be fine. Yay!!

[jillypie 0]

Yeah, but be careful...I submitted everything to Aetna, was ready to rock and roll...until they denied me because I hadn't been at a BMI of 40+ for 2 years.

I dipped down a little bit back in January of 2006 (I was taking phentermine) so they denied me.

It so hard to grasp the concept of, "We see that you have struggled since at least 2000 when your medical records start, but since you were able to lose some weight at one point, too bad."

I am totally devastated.

If I had gone through my paperwork and taken out the one that showed me at a lower weight, I would have already had the surgery and be on my way to good health. But since I was honest, I am being punished.

I can't afford self-pay and would need a co-signer if I got a loan, which would be a struggle to pay every month but I would have to do it if I want the surgery.

I wrote an appeal letter yesterday and I am praying they have a change of heart. Otherwise, I have to find a way to get $17,000.

Please keep me in your thoughts if you would!

[Flowerpurr 0]

From what I am told they can't deny you just because you bmi dropped for a short period. I would forsure fight that. I have been on the pre-surgical diet for three months now and I have lost 30lbs. Though my BMI has been over 40 the past five years and still is. What are they going to deny me because I was able to lose 30lbs. Just keep appealing you will do it. Did you submit all your diet infromation to them? If you read their terms carefully they want you to lose at least 10% of your body weight before surgery as well. So fight, fight, fight, is all I have to say! Good luck I wish everyone all the best.

[lonestar5212 0]

I have Aetna POS II. The criteria for me was a three month supervised diet and exercise plan. They did not require 6 months for me. I only lost 13 pounds on the 3 month diet. I started with a BMI of 40, had a 39 when I submitted. I was approved.

Had surgery and all is great!