Aetna

[mlonginotti 0]

Hello all,

I have been completing my requirements for the lapband put forth by Aetna. During this process I have been reading the posts on lapbandtalk.com regarding Aetna, their process, denials, appeals, etc. The posts were about 50/50 on who was approved and who wasn't, who had to got through a lot to get the approval and so on. I was slightly worried, but still keep the hope that I would be approved the first time, even if it took a year. I have to say that I am very impressed by Aetna now that my surgery has been approved. I started the 6 month supervised diet in June, the last appt. was Nov. 26th. I went in to my lapband doctor on Dec. 2nd, turned in my records for the six month diet (yes, i handed it to them (doctor's staff) myself), talked to the doctor about what would come next, etc. The clinic turned all my paper work in, along with my dictation from the lapband, recomendation from my PCP, etc. on Dec. 10th. I called Aetna every Friday to get an update on my case. On Dec. 30th, about noon, an Aetna rep. called me and informed me that I had been approved. A few days later, a got my approval letter from Aetna.

The main purpose of the post is to encourage those going through the process with an Ins. company to keep pushing and have hope. If you get denied, try again. I truly believe that what really helped me get the approval the first time is the fact that I have a really good, experienced lapband doctor, and I completed everything required by the Ins. company BEFORE anything was submitted. The only thing Aetna did not have me complete is the Psy. Eval., because I don't have a history of mental illness....but, my lapband doctor requires it before surgery to make sure that the patient is prepared to go through with the surgery and to understand what is all involved post surgery.

Don't give up, if it is meant to be, it will happen.

Erika:thumbup:

Edited January 15, 2009 by mlonginotti

[Jaxjulie28 0]

I agree with you. Sometimes you have to fight with the insurance company. I also have Aetna and just got approved today. I can't really say anything bad though because it was just submitted this past Thursday and I got approval today.. I can't wait to get the surgery done and over with so I can start my new thinner life!

Julie

[tashanicole1271 0]

I have Aetna too and I was very impressed with how quickly I was approved after submitting everything that was required. I was a bit sceptical reading some of the posts and what some had to say about Aetna, but I went for it anyway.

I was banded today and I look forward to this journey.

[mlonginotti 0]

Happy to hear. :thumbup:I go in this wed. (1-21-09) to discuss a date for surgery.

I too was skeptical, but i also know that everyone is different, so I figured why not, if I was denied, i wouldnt really lose anything, i would just be in the same situation (maybe a little disappointed).

GOOD LUCK ON YOUR JOURNEY. I will keep u and others informed on my journey.

erika

[tashanicole1271 0]

Good luck on Wednesday!

[mlonginotti 0]

Julie,

we were approved within a few weeks for each other, maybe we will be banded about the same time too. we should keep in touch with how each of us is doing. After i get my surgery, i am going get one of those giga (or whatever) counters on here to show my progress. If you dont mind telling, how much do u weight now, and how much do u plan or want to lose? I weight is 245ish right now (ht. 5'4" BMI 41 or 42) and my plan is to lose about 100 lbs. That should put me right at my healthy weight.

Erika

[mlonginotti 0]

Thanks.

So since u were just banded today, how do u feel?

Keep us updated.

Erika

[tashanicole1271 0]

Well, I was actually banded yesterday and I am doing ok. I am a little sore in my stomach and my back. I also feel a little tight.....what some of these pros on the site compalin of! I am sure my tightness is do to swelling.

[misslonglegs 0]

wow..happy to hear people getting approved by artna,i finish mu 6 month in feb,hopefully ima amoung the lucky ones to get approved.

[IURN62 0]

I called Aetna today (I have Aetna POSII) and they said they dont cover the surgery. Is it because my employer doesnt want them to cover it? Im confused. I qualify due to my weight and medical conditions. A big letdown

[Jaxjulie28 0]

IURN62,

Aetna does cover it if your employer chooses to have it covered. It sounds like your employer chose not to cover the procedure. I would check with your employer to see if there is some kind of an exclusion before you take no for an answer. Sorry

[IURN62 0]

Cant get a straight answer from anyone. I will go to the seminar on Saturday and see what help they can provide. Thanks for your post.

[tashanicole1271 0]

IURN62,

I have the same Aetna plan as you do and I was banded on the 14th. Your company does have to include WLS in what they will cover, but I wouldn't give up. Just check and send if there are ant exclusions.

[lil miss scare all 0]

I also have Aetna PPO and was approved really fast , with no hassles whatsoever. I was actually a little surprised by the quick approval. Now i dont feel bad about the outrageous cost of insurance that Ive been paying over the years. Im finally gonna get something out of it :w00t:

[Stormie 0]

Hi Lil Miss,

Sounds like you opted for the 3 month Aetna plan. Did you begin dieting right after meeting with the dietician? What did you do for the exercise piece? The 3 month plan requires an exercise regimen and I am not clear on what that means. Would a Curves program suffice? Are there any other details you can share? I had my consultation with my surgeon and meeting with the dietician last week and have an appointment for psyche eval on Tuesday. I would love to do this in 3 or 4 months as you have. I am so excited to finally find a solution that will help me keep off the weight I lose. Good luck to you and thanks for sharing your experience with Aetna. I agree, feedback has been 50/50.