AETNA anyone?

[babegreen 0]

I just scheduled my first consult with surgeon....is aetna gonna make me wait forever? I haven't a clue, can someone that has Aetna weigh in on some of your experiences? Oh yeah I have the POS(no referrals needed) not the HMO, thank you in advance.

[lindas0809 0]

I have aetna too (HMO). First I've assumed that you made sure your plan has WSL coverage(not employers take that). I opted to do the six month plan of just having a Dr. supervised weight loss plan. They also offer a 3 month multi disciplinary(diet & exercise) plan. Other than waiting the 6 months, I had a good experience with Aetna's approval process. Good luck!

[babegreen 0]

Thanks! Yeah I've called them already and they cover all types of Weightloss surgery including the lap band..they cover 90% after the $100 deductible.... so I'm keeping my fingers crossed hoping everything runs smoothly

[ahb08 0]

Thanks! Yeah I've called them already and they cover all types of Weightloss surgery including the lap band..they cover 90% after the $100 deductible.... so I'm keeping my fingers crossed hoping everything runs smoothly

hey babe, i have aetna pos 100 also....and my surgery will be covered at 90/10....so my out of pocket max for my insurance is 2000 including the 100 deductible so really after i meet my deductible i will pay no more than 1900 which i signed up for a health care spending account with my wonderful job so that i wont have to come up with the money upfront....b/c i do know that lapband usually costs between 25k-35k for insurance patients..so 10% of that..will still be in the $2000+ range. my approval only took 1 day....i did the 3 month one and i didnt have to do a pysch per insurance or doc, and i accidently skipped one month's visit but made it up end of april so that unfortunately prolonged the process, but didnt deny the surgery..which is what i was more concerned about....

let me know if you have anymore questions..

[babegreen 0]

Thanks so much for the heads up!

[stellaabbey 0]

Don't forget to ask Aetna for their weight requirements which is also specific to your plan.

My BMI was 39.9999999999999 and I had high blood pressure. I was denied by Aetna POS 3 days before my surgery.

My weight history, was not enough to qualify.

I ended up paying for my surgery myself but I plan on appealing Aetna.

[Ridgies Rock 0]

I also have Aetna POS, so my co-pay is only $100 for the surgery. As long as you meet all your pre-op appointments you shouldn't have to wait any longer than a few weeks after the completion of the pre-op time (for Aetna it's usually 3 mos.). I literally just finished all my appointments two weeks ago. I called the insurance person at my surgeon's office and let her know so she could make sure it was submitted asap...and Aetna had it approved 4 business days later! Needless to say I was amazed at their turnaround time. I was able to schedule my surgery for three weeks out after that and I am going in soon! I hope yours goes just as well!

[HappyHomeCC 2]

I have Aetna Choice POS II and I am on a 3 month hold, I talk to the nutritionalist 3 times and that is about it.. 90/10 coverage.

I am about half way through right now... I think it is good to have that hold ... gives time to really think and research what products you want to use, think of all your questions, reformat the pantry LOL. Figure out with your husband or significant other what meals will look like later and how he can support you. I have my daughter who is 11 reading labels for serving sizes etc! I decided to go for counseling on my own aside from the psych eval they did for the insurance. I have my first appt on Monday.

[jkmccowan 0]

Hi HappyHome! I have Aetna POS II and am trying to find out what the 3 month wt loss program consist of my surgeons office is clueless and keeps telling me its a 6 month program but I wanted to do the 3 month one because I'm tired of waiting. I've been working on getting approved since Feb. and they are just now telling me about a wt loss program requirement ugh..any advice you have would be much appreciated thanks.

[HappyHomeCC 2]

Hi HappyHome! I have Aetna POS II and am trying to find out what the 3 month wt loss program consist of my surgeons office is clueless and keeps telling me its a 6 month program but I wanted to do the 3 month one because I'm tired of waiting. I've been working on getting approved since Feb. and they are just now telling me about a wt loss program requirement ugh..any advice you have would be much appreciated thanks.

I have only been told about the nutritional counseling and I have been talking with her via email and phone, I haven't had to go see her in person. She said they like to see a few pounds lost ( but not to much or you could be denied) She says I am at 42 BMI on the paper work so I have "wiggle room". Basically she sent me an email packet of stuff and we have had discussions. I can email you the packet if you like!

[jkmccowan 0]

Hey HappyHome! Thanks for responding. If you don't mind emailing me the packet I would appreciate it my email is jkmccowan@valdosta.edu My BMI is at 37 but I have sleep apnea the doctor told me not to lose any weight but now they tell me to do a weight loss program ugh I'm confused lol

[HappyHomeCC 2]

Hey HappyHome! Thanks for responding. If you don't mind emailing me the packet I would appreciate it my email is jkmccowan@valdosta.edu My BMI is at 37 but I have sleep apnea the doctor told me not to lose any weight but now they tell me to do a weight loss program ugh I'm confused lol

I sent out the packet to you hope it helps

The way I understood was they want you to lose a couple of pounds and stick with it so to show staying power commitment etc. I don't get the feeling that the professionals on our side want us to lose a lot of weight and get the BMIs down .. LOL then they lose business because our insurance may deny the procedure... I told my nutritionalist so what happens if I lose too much will they deny me? she told me "we wont let you " I just had to laugh.

[jkmccowan 0]

yeah its funny my whole life I've been trying to lose weight and now I find out I would be approved if I was heavier. I wish I could have done this years ago I about killed myself working out all the time and starving myself when I was younger got down to 130 and everybody told me I needed to eat then I eat and am told I need to diet can't win for losing. I want the band for me not to please anyone else just want to feel better and have more energy. Also, want to be happier with myself.

[heatherpretz 0]

any one have aetna EPO? need some advice....

HEather

[HappyHomeCC 2]

yeah its funny my whole life I've been trying to lose weight and now I find out I would be approved if I was heavier. I wish I could have done this years ago I about killed myself working out all the time and starving myself when I was younger got down to 130 and everybody told me I needed to eat then I eat and am told I need to diet can't win for losing. I want the band for me not to please anyone else just want to feel better and have more energy. Also, want to be happier with myself.

how much heavier do you need to be ????