Approved! Aetna PPO

[laurieanns 0]

Just received the great news i was approved by Aetna PPO for lap band surgery on May 18th 2009! :thumbup: I did the three month program through Columbia/St. Mary's /Dr. Regan. I was afraid of my final weigh in since i had gained all the weight i had lost for the first two months back. But, i pressed in and did a Protein diet/exercise for the last ten days and dropped all that weight plus another 3 pounds!!! The approval went through in 2 days!! I am very happy, since i was fearing that it would take a couple of weeks and i had heard conflicting stories about Aetna... The staff at St. Mary's/Columbia really know how to coordinate and get approval, i would recommend them to anyone in my area. They called and left a message right away to let me know as well. :tt2:

[lisac82 0]

Congrats!!! I am waiting for my insurance approval to go through too and I have Aetna so I am hoping I have the same luck as you :thumbup:

[zukagirl22 1]

congrats!!!!!!!!!!!!!!!!!!!

[ahb08 0]

Just received the great news i was approved by Aetna PPO for lap band surgery on May 18th 2009! :thumbup: I did the three month program through Columbia/St. Mary's /Dr. Regan. I was afraid of my final weigh in since i had gained all the weight i had lost for the first two months back. But, i pressed in and did a Protein diet/exercise for the last ten days and dropped all that weight plus another 3 pounds!!! The approval went through in 2 days!! I am very happy, since i was fearing that it would take a couple of weeks and i had heard conflicting stories about Aetna... The staff at St. Mary's/Columbia really know how to coordinate and get approval, i would recommend them to anyone in my area. They called and left a message right away to let me know as well. :tt2:

im with aetna ppo also, but unfortunately i gained 8lbs during my 4 mnthly visits.......did they tell u, u would be denied if u gained weight?....i figured i had to gain weight because at my initial weight in i was exactly 40.00 at my final i got up to 41.....i didnt want to be right at 40 and then go on a diet during those 3 mnths, and not get approved b/c my bmi fell below....what was ur initial and last bmi?

[Jodi73 11]

Can you tell me exactly what you did for the three month diet? I have Aetna POS II and I keep getting conflicting info on the nutritionist requirement. The CPB on their website is just not clear to me! As in, do I need to see them (nutritionist) once, or for all three months? Any help would be greatly apprecaited! Jodi

[HappyHomeCC 2]

I just looked at my card and I have Aetna Choice POS II does anyone have experience with that facet? I did the prequalify on the phone and they said I have great coverage... I have a consult on Thurs and I am nervous... I also realized I am an inch shorter than what I told them on the phone so my BMI is just squeakin' over 40

Insight anyone???

[laurieanns 0]

Hi there,

Ahb08, I would call your doctor's office and ask them what they think you should do, i would think they would not want you to go below 40 bmi though, possibly stay the same weight aka lose 8 lbs.; but not go below 40bmi before approval?? Ask them " Do you usually get approval from aetna ppo with this regime, Has anyone ever been denied? What about the weight gain, has anyone ever been denied for gaining or being at 40 bmi exactly?

Waynes6,

I just cut out almost all sweets, and most of the high cal foods, like potato chips, butter,corn chips, Bagels, ect. I logged what i ate on "My Plate" and i would make sure i was exercising... walking an hour a night at the gym on the treadmill and doing crunches.... I lost 7 pounds. I actually gained back 3 and had to lose it again!! I got sick for 2 weeks with that flu i think and i actually gained??! I have read on here that you do not want to lose more than 10 pounds during the 3 months.... My nutritionist just had me bring in a few days printout of my online food diary ~~ "My Plate" and i brought in my workout routine printed out too. You should be working with a facility that puts the whole package together for you, all you do is schedule appts. with the physical therapist and psychologist and your primary care physician. To find a actual Bariatric Center within a hospital that does this {puts together the pre-req's for insurance} is A Must!! They should be putting it all together because they will know what it takes to get approved, and who to call ect.... I met with a nutritionist, nurse, & surgeon every time i visited. They guided me through the entire process, this is what you want to find first off; If i did not have that now where you are you might want to look at Obesity Help and read reviews on the centers and surgeons near your area. I personally went with what i knew was a top ranked hospital in the first place and then checked out their seminar, and decided that it was where i wanted to go. They had good reviews but they were not too over booked...

[Jodi73 11]

I called Aetna yesterday, and I still couldn't get a straight answer. The person did a live chat with someone else and everything. I was trying to figure out if I needed to go to the nutritionist once every month for the three months, just once for the whole thing or what....she said I needed to go weekly, to the nutritionist, excercise therapist, etc..., I said I really did not read that in what I have read on the website. Thats when she did the chat, then came back and said my PCP just needs to coordinate with the nutritionist, and document the excercise, etc. So basically, I am still not sure what coordinate with the nutritionist means. Monthly, weekly or what! Geeze, the 6 month diet is souding easier right now, whats another three months for the rest of my life right! No doc around here offers the Multi-Discp. program, so I am kinda on my own with this, any help would be greatly appreciated! Thank you, and congratulations! Jodi

[adagray 1]

Congrats to Laurie!!!

Jodi, I understand your frustration w/the 3-month requirements. I read them to mean that you go to a nutritionist, exercise therapist, and behavioral therapist every month, but I don't know if I'm interpreting it right either. In the end, I decided to just do the full 6 months. In my case, I felt like I could use the extra time to get my head wrapped around this big change anyway. And, instead of going to my PCP, I'm seeing a doctor at my surgeon's office for the 6 months (and she is also a nutritionist). She's also been really good at helping me w/the psychological aspects of this all. So, I feel like the 6 months is worth it to me. So much of this is getting your head in the right place so I don't mind waiting a little longer. And, 3 appointments every month would be hard for me since I have two little kids.

[Lady Lap Band 71]

hey that is SOOO exciting! I have aetna too and I was surprised how easy it was to get approved. I was approved as of March 9th and my surgery date is June 19th! Let me know what you find out your surgery date!

[laurieanns 0]

Hello again,

Thanks to everyone! Gonna Lose it... Yeah i was floored how fast they responded with the message that i was approved! Right now i am on the liquid diet, which is okay since i took in suggestions of what i wanted to use and they let me use it!! I am losing alot on this liquid diet, i can't believe it, like 2 lbs. every time i get on the scale! Well, today My surgery letter arrived: the 18th of May is my surgery date.

Waynes 6, I would drive if i had to to save the task of appealing to the insurance company, exsp. in this economy....I would try and find someone who does all the organizing and submission work for you. I know people here in wisconsin have driven 2 hours just to get a physician who is specializing in bariatric surgery and staff that is experienced in it as well. I have also heard appeals can be a real pain so that is what i would recommend. My meetings were once a month for three months and 2 separate appts. with the physical therapist and psychologist. A total of 5 appts. Well No Matter what you choose, I wish you well!!

[Lady Lap Band 71]

Hello again,

Thanks to everyone! Gonna Lose it... Yeah i was floored how fast they responded with the message that i was approved! Right now i am on the liquid diet, which is okay since i took in suggestions of what i wanted to use and they let me use it!! I am losing alot on this liquid diet, i can't believe it, like 2 lbs. every time i get on the scale! what you choose, I wish you well!!

What are you drinking on your liquid diet?

[laurieanns 0]

I am drinking Optimum Nutrition[ON] Gold standard whey powder. It is what all the weight lifters drink. It tastes great too! I have tried lots of different whey powders and i like this one best for variety, quality, and taste. I mix it with frozen strawberries, blueberries, or banannas and Water in my blender.... 24 gr of Protein with 110 calories a scoop, the fruit is about 80 to 100 more calories. I like the chocolate mint, strawberry bananna, double chocolate, eggnog{believe it or not it's really excellent with frozen bananna} They have about 20 different flavors.... I am rotating this with Zone bars, they are really good too. I can't believe how much i am losing!! I am down seven pounds in just a few days!! :grouphug: [at that time of the month too] Well anyway....sounds like i am a salesperson for on or something!:thumbsup:

[ahb08 0]

I called Aetna yesterday, and I still couldn't get a straight answer. The person did a live chat with someone else and everything. I was trying to figure out if I needed to go to the nutritionist once every month for the three months, just once for the whole thing or what....she said I needed to go weekly, to the nutritionist, excercise therapist, etc..., I said I really did not read that in what I have read on the website. Thats when she did the chat, then came back and said my PCP just needs to coordinate with the nutritionist, and document the excercise, etc. So basically, I am still not sure what coordinate with the nutritionist means. Monthly, weekly or what! Geeze, the 6 month diet is souding easier right now, whats another three months for the rest of my life right! No doc around here offers the Multi-Discp. program, so I am kinda on my own with this, any help would be greatly appreciated! Thank you, and congratulations! Jodi

U only need to go to nutritional visits 3x's during that 90 day period, and u need to see the specialized physician for bariatric surgery 4'xs (which consult visit is included in those 4 visits), as far as a psych, it states on the aetna website that its only needed if the patient has had PAST PYSCHOLOGICAL PROBLEMS....i dont have any so if it wasnt required by my surgeon i just didnt do it at all...now keep in mind im still waiting for my charts to be submitted to insurance.....so they might pull the psych visit on me...but it clearly states the need for a psych visit on the aetna website. So im still praying to god this goes smoothly!!!

[jaredsdad 0]

Hi, new guy here. I have Aetna PPO and have been working with a bariatric surgeon since February.

On my first consult he told me that I needed proof of 6 months worth of visits to my PCP on weight loss for Aetna to approve me.

He gave me 6 sheets that the PCP can basically fill out, it has current weight, diet plan (calorie intake, etc) and excerise plan.

I have went every month since Feb (this month will be month 5) and my PCP is filling in what diet plan and exercise plan I've been on.

The bariactric surgeon said his office will submit all 6 forms (once I have all six) to Aetna for approval.

DOES THIS SOUND RIGHT? DOES IT SOUND CLOSE TO WHAT YOU THAT HAVE BEEN APPROVED THROUGH AETNA HAVE DONE?

In addition to the monthly visits to my PCP to fill out my form, I also had a consult with a nutritionist and a pyschologist.

PLEASE PROVIDE SOME INSIGHT FOR ME!!!!

5 months into this process...and the whole time wondering if Aetna will approve me!

Thanks

Jaredsdad