Insurance (Aetna)

[MaryE 27]

Help! I am just getting started. I have Aetna Insurance and live in upstate NY. I have been told by the surgeons office I wish to use that Aetna never approves the lap band surgery. My BMI is under 40 (38) and therefore they want me to have some comorbidities. If Anyone can help please.

[changing 2]

hey i live in ga and i have a bmi way over 50 with comorbidities but do to the aetna plan i have it does not cover it.good luck.I was told it comes down to the particular plan.

[tashanicole1271 0]

I live in Memphis, TN and I have Aetna also. I just completed everything and turned in all my paperwork to the doctor to be sent to the insurance company. When I started the journey, my BMI was slightly over 40 with no comorbidities, or so I thought! If you don't have any known comorbidities, I would suggest you go to your PCP and have them check you for EVERYTHING! It turns out that I have slightly elevated blood pressure that could be weight related and a bad left knee that has been carrying to much weight. Don't give up. Find another doctor if you have to. I have come to realize that a weight issue is usually accompanied by something else!

[kossde 6]

Hey you know, Aetna approved me immediately. Of course, my BMI was about 55 (now down to 35)

Do you have any comorbidities? I think even one would be enough. Have you had sleep tests for sleep apnea?

[nicole242 0]

Hello, My doctor told me atena does approve people however there are things you must do first...... it is a lot of work, maybe your doctor just does not want to help you through it. I just sent my paper work in today. here is what I needed to do.

1. 5 years of med. records including weight records.

2. a 3 month doctor followed diet plan along with a letter from a family doctor stating the reason this surgery should be done.

3. a 3 month documented meetings with a diatician during which you must keep a food/exercize log.

4. monthly weigh ins with your family doctor.

5. a phsyc evaluation.

I am not 100% sure that I will get approved, but my surgeon and his staff helped me the best they could.My suregeon said people from Atena do get approved if these requirements are met. I have pre diabetis and my bmi is about 40. I hope this helped please feel free to e- mail me with any other questions. Best of luck!!!

[nicole242 0]

*********** please excuse my spelling mistakes ********

[silvers320 12]

Mary

I live in Upstate NY (the Hudson Valley) and have Aenta. I had a BMI of 41 to start with co- mos but still had to fight - some of which was fighting due to documents never getting to where there were needed.

Nicole is pretty right on - There are 2 options - the 3 month diet and the 6 month - both of which must be under medical sup/ with documentation .

I will say this that if you are denied after doing what Aenta requires NYS has an independent review process - it will cost you $50 unless the find for you - in which case its free. That's final the route I had to go.

[changing 2]

i have issue with my knees hurting as well a my back.I have been diagnosed with severe sleep apnea.I take a diuretic for swellin gin my legs and feet.BMI is actually about 64.All of this documented along with other info that my doc submitted.They denied it saying something about and exclusion.so i am just tired of dealing with them back and forth.at this time i do not have the money to pay for it.i am so terrified at even trying to lose again on my on because i know what always seem to happen.

[tashanicole1271 0]

Mary,

I received my approval letter from Aetna today! I had my last monthly visit to my PCP on 11/7/08 and the approval is dated 11/19/08, the turnaround time was pretty swift. I don't know if your Aetna is the same as mine, but I'd be happy to tell you everything I did to get approved. I hope everyone had a wonderful Thanksgiving!

[nicole242 0]

I was denied, my plan does not cover the surgery at all, the doctors office never call to check until after they took over 300.00 from me with doctors visits co-pays and a phsyc. eval. that cost me 150.00. I am very upset that they did not call before they had me jump through hoops for 6 months. I may self pay but .... at a different clinic beware of DR. Monash in Tucson AZ his office girl Stephanie does not know how to do her job.

[nicole242 0]

Oh I failed to tell you in my last post that no paper work was ever sent in, they made a phone call that was all. when I myself called aetna they told me that if they would have called 6 months ago that would have saved me a lot of money, because they would have been told my plan does not cover weight loss surgery.

[changing 2]

i think it is just sad that all insurance companies don't cover something that could ultimately prevent more complications.what is even sadder is that fact that we pay for the insurance and can not utilize it for our best interest.aetna along with others should not have all theses different plan with and without exclusions.it should only be one version of aetna.i will be dropping cover at this open enrollment.there is no reason for me to pay 200.00 biweekly for nothing.or may i will go ahead an have all the procedures my pcp feel i need such as surgery on my knees.:cursing:

[MacMadame 81]

It's not Aetna's fault. It's your company. They chose not to cover this lifesaving surgery. Plus, if you have other choices at Open Enrollment, it's unlikely your company is paying for WLS on any of the policies they offer.

That's my situation. Aetna has actually been very good to me. They have paid for every pre-op tests, all post-op meds, etc. It's only the surgery they don't pay for and that's because my company didn't include the coverage.

So it's my company that I'm mad at. They cover IVF, they are talking about covering sex change operations, they give us $300 to join a gym and a discount at Jenny Craig but they won't cover WLS. Morons.

[nicole242 0]

I did not say it was Aetnas fault at all!!!! I am upset with the suregeons office for not calling first " like I thought they had" before they had me do everything else. I am NOT upset with the insurance company at all!!!

[tashanicole1271 0]

Before I started the process at all, I called Aetna myself to see what exactly they covered or did not cover as far as WLS was concerned. That is what your surgeon"s office should have instructed you to do. These surgeons deal with so many people, with so many different insurances that they don't really know who covers what! I work with insurance on a daily basis and it is your company who chooses the plans. Before it's time for you to sign up, I think you should try to find out which covers what. This might aid in your decision.