Aetna....Super Discouraged now

[sammyxann 0]

Does anyone know what aetna's policy on lap band is? I went on their website and got some information but then when I ran a search it said that Aetna is now requiring a complete medical history, you must have had a BMI of over 35 for at least 2 years (2 years ago mine was 33.3) must have a medically supervised diet for 2 years. Anyway, does anyone know what the current requirements are? My hubby just passed 90 days at a new job and our insurace will be effective Jun 1st so i can't call and find out yet.

I am currently on Kaiser Cobra and wondering if I shoud just stick with that and try to get them to cover it.

Any info/suggestions would be greatly appreciated.

[Flowerpurr 0]

Hello,

I am going through it now. You don't need a medically supervised diet for the past two years. You need to have done a diet in the past two years that was medically supervies otherwise you have to do either a three or six month diet depending on how much money you are willing to spend. I did the three month route and spent a ton but worth it as long as I get approved. Good Luck.

[yayamama76 0]

It took my six months and 2 denials to get approved through Aetna. I finally ended up with a peer-to-peer arbitration between my surgeons office and Aetna. We won!

I was banded two weeks ago and I feel so fortunate! I'm on my way now.

Don't give up - if they tell you no, ask them what the next step is for you. If the procedure is DEFINITELY covered in your policy and you are sure the meet the quidelines = make them work.

Good luck!:thumbup:

[boomboom 0]

I have just received my second denial in the mail yesterday. I was tring to find out if anybody could help me with my situation. Apparently I dont meet Aetna's criteria of bmi of 35 with one of the 4 ilnesses. I have copd, asthma, urinary stress incontinence, venous insufficiency and severe degenerative arthritis. I was hoping maybe you could let me know what to expect at the external review. :sad:ote=yayamama76;836848]It took my six months and 2 denials to get approved through Aetna. I finally ended up with a peer-to-peer arbitration between my surgeons office and Aetna. We won!

I was banded two weeks ago and I feel so fortunate! I'm on my way now.

Don't give up - if they tell you no, ask them what the next step is for you. If the procedure is DEFINITELY covered in your policy and you are sure the meet the quidelines = make them work.

Good luck!:tt1:

[yayamama76 0]

Ask them why your claim was denied. Tell them you need to know specifically why you were denied. If they say you did not meet the criteria, ask them which part you didn't meet. Also - you might want to try going through a company (I used Lapband Solutions). those people are used to dealing with the insurance companies. They are the ones who did my peer-to-peer review and were able to push my claim through after 2 previous denials.

Good luck!