APPROVED - Aetna POS II

[jaredsdad 0]

Finally got all 6 months 'weight loss management program' done...I gained 12 pounds over the 6 months.

Only had verified weights from 2002, 2005, 2006 (Aetna requires 2 year history).

Submitted by surgeon on Friday 7/31....APPROVED for lapband 8/3.

I'm excited. LOOOOONG road since Feb 2nd when I saw the surgeon for the first time.

Scheduler is on vacation this week, but is calling me Monday to schedule surgery!

[Jodi73 11]

CONGRATS I just finished the 3 month multi program. We are submitting this week ! Hope mine is as easy as yours! Jodi

[BigMomma 0]

CONGRATS I just finished the 3 month multi program. We are submitting this week ! Hope mine is as easy as yours! Jodi

I am currently working on the 3 month multi program. What did you submit for the exercise requirement?

[Jodi73 11]

My insurance coordinator and I read and re-read the bulletin on Aetna's website. We finally determined that as long as my PCP noted excercise on each visit, along with behavior modification, etc...that that would suffice. I do not have approval yet, they just submitted today I believe. As for the nutritioninst, I went to one official appointment with her, then also had 3 classes that she was present at/taught at as well. We sent a letter documenting all of the "visits" with her.

Some people go to 3 visits with all three entites (nutr, excercise ther, and pcp). My coordinator just did not read the bulletin that way, and neither did I . We will see if we are correct I suppose. Let me know how yours goes! Good luck! Jodi

[shart4 0]

I was just approved by Aetna yesterday. I did not have an exercise person. The nutritionist and the doctor noted I was exercising. I had four visits with both which is the three full months Aetna requires. Hope this helps.

[BigMomma 0]

I was just approved by Aetna yesterday. I did not have an exercise person. The nutritionist and the doctor noted I was exercising. I had four visits with both which is the three full months Aetna requires. Hope this helps.

How long did take to get approved?

[BigMomma 0]

Thanks Waynes6 and Shart4 for the information.

[ahb08 0]

Finally got all 6 months 'weight loss management program' done...I gained 12 pounds over the 6 months.

Only had verified weights from 2002, 2005, 2006 (Aetna requires 2 year history).

Submitted by surgeon on Friday 7/31....APPROVED for lapband 8/3.

I'm excited. LOOOOONG road since Feb 2nd when I saw the surgeon for the first time.

Scheduler is on vacation this week, but is calling me Monday to schedule surgery!

congrats to you...now that you got that weight off your shoulder now you can focus on gettin the REAL WEIGHT off...!!! im only a month and half out from being banded and its a tough road but no big regrets about doing it soo far...i too have aetna pos II and i remember the days worrying that i would be denied....now im taking advantage of my insurance b/c i have met my out of pocket max for the year so until the last day of this year all my medical expenses that in aetna network are free, so you better believe im getting xray fills every month and and doing other medical maintainences....lol!!

[shart4 0]

My sleep apnea study was the hold up. I had to have the sleep study done again. It was much worse, so once the new study was submitted, I was approved. That was on my second appeal. Aetna must respond in 15 calender days. The first two times (with denials due to "not significant" sleep apnea) it took the 15 days. With the new sleep study, I had an answer in four days.

Make sure you send your medical records with two years history in with your paperwork. I had to send those in the first appeal because my doc had only noted I had a two year history with no proof. Good luck! Let me know if you have any more questions!

[BigMomma 0]

Did anyone lose weight while on the supervised diet? My weight keeps going up and down and I'm worried Aetna will deny me.

[WDW Luver 0]

Congratulations!!

So that is what Aetna has been doing! Approving all of you instead of me! I am jealous!

The WLC submitted my paperwork with my weight history for the last few years and a letter from my PCP and their visit information on July 13th. Except that I didn't have my last PCP visit until July 16th! And I didn't have all the office notes from those visits until the next week, around the 20th.

So of course Aetna kicked back the first one for more information. Then once they had all the paperwork I thought I would hear. Nope. Called last week and they needed to talk to the WLC office for something but couldn't get through. I called them, they called the insurance company today to give them what they needed-- the insurance liason told me today that they asked for information that was already sent.:smile2:

So I am waiting. And waiting. And waiting.

I am going to call them again tomorrow. I am calling every 2 days. Maybe if I bug them to death they will push me through!