Anyone with Aetna Insurance ???

[kay Ellen 0]

There must be different policies under Atena because I was denied and they told me that no matter what I did it would never be covered. I went self pay and don't regret my decision to have the band.

[southerngal75 0]

I have aetna, and the particular policy that my husbands company purchased does not cover lapband. Good luck!:scared2:

[Lo4813 0]

So I was approved today!!! My paperwork was submitted last Tuesday and today I was approved. One week exactly. Very fast. I did only the 3 month weightloss program and my BMI is over 40. i was very suprised that I was approved to tell you the truth. i thought I would have to jump through more hoops to get approved but it was easier than I thought. My surgery is Nov 11th. whats your progress with everything?? update please!!

[ashleyw889 0]

My appeal got denied. All because my BMI isn't high enough. Now I'm looking at self pay options. I gotta get a loan somewhere.

[HappyMe2009 0]

My appeal got denied. All because my BMI isn't high enough. Now I'm looking at self pay options. I gotta get a loan somewhere.

I am sorry to hear your appeal was denied.

I only pray that my appeal will be approved with Aetna, but with my BMI not being over 40, I am doubtful. My surgeon's office suggested switching insurance during open season and they recommend BCBS because they are more lenient. If I am denied on my appeal, I will look in to that and then self pay will be my route. Good luck on getting a loan. Have you tried carecredit.com?

[ashleyw889 0]

No worries! I kind of knew it was going to happen. I'll keep my fingers crossed for you!

I looked into carecredit, but from what I can tell, your doctor has to accept carecredit. At least that's what I'm getting out of the site. My doctor isn't on their list of doctors.

[sherrita3 0]

Hello,

I hope everything went well. I have just completed all of my requirements and my folder should be sent off tomorrow. I wonder how long does it take for Aetna to approve someone? I am anxiously waiting and will continue to stay positive. What happens after you receive that call, or approval letter? What are the next steps?

[sherrita3 0]

Why do you think you got denied? This is driving me crazy! I have so many feelings right now. I am so sorry to hear about your status. How long did it take for you to get a response from aetna? Good luck to you...................

[lipstix64 1]

What about asking your docs to up your BMI? Or, do you have any co-morbidity issues, like High Blood Pressure or Diabetes, shortness of breath, Heart Murmur? I as denied by Aetna at first thinking that they just denied me because they didnt want to cover it. But, it turns out I was denied because the initial doctor I picked was out of my network. I didnt know that was the reason. I jsut assumed I was denied because they didnt want to cover the surgery. I called back months later to find this out. I chose another doctor in my plan and had the surgery on October 16th, 2008. Have your insurance person at the docs office keep pushing until you are approved. My office sdoes that and gets alot of approvals that way. Good luck. PS- Ive lost 82 pound so far!

My appeal got denied. :biggrin: All because my BMI isn't high enough. Now I'm looking at self pay options. I gotta get a loan somewhere.

[cajungirl 0]

So I just got home from overnight visit in the sleep clinic...and I passed--bummer ! No sleep apnea. With a BMI in the high 30s, I have to say I'm a bit worried about approval but I'm gearing up for the battle. I'm not ready to take NO for an answer !

[lia3131 0]

i have aetna pos excel plus plan in which do anyone know if they would allow revision from rouxen y to a band? i have had problems with gastric bypass i got it 11/21/03 and my stomach hurts constantly had a undiagnosed hernia for 4yrs finally got that repaired in 2007; weight loss is terrible i started at 251 went down to in 2004 now back up to 217 i have tried everything and i am considering the band over the rouxen y; i have a egd scheduled to see whatelse is going on; if i had done my research like i should have i would have chose the band; also at the time i had gastric bypass i had united health care and they approved me asap; i didnt have to have any history of diet; my bmi was 42 and i had sever high blood pressure thanks

[aubiefan143 0]

Hey y'all I have Aetna, I am 5'6" and weigh 260. I have had high blood pressure for years and now I have "bad knees". (just had surgery in March)

Can anyone tell me what is involved in the 3 month multdisciplinaryprogram. Is a sleep study for sleep apnea part of that or is that something I should have done on my own.

I will be going to a seminar next Sat. I have already called my insurance and they do cover the procedure if I meet all of the requirements.

I am just trying to get a head start on what to expect.

Thanks

Penny:thumbup:

[cajungirl 0]

Your best bet is to call Aetna and get the numerical code for obesity surgery requirements. The site spells it out very clearly to include co-morbidities and required BMI and either 3 or 6 month diet and exercise program that they require. You'll need to get copies of 3-5 years of records from your primary care MD to show your height and weight. They may require copy of your pharmacy records to show either blood pressure or diabetic or cholesterol meds that you take. You may not even need a sleep study - wait till your bariatric MD prescribes it and Aetna will cover it. I'm in the last month of my 3 month program and am hoping for approval in late Nov. God Luck !

[WhyW8 0]

My plan required the 3 mo. of nutritionist, doctor check ups, psych evalu., 2 years of weight problems, etc. When I made calls to Aetna to check on requirements I was given one answer then another when I called back. Double check your yes and double check your no!!!!

When my surgeons office submitted my papers my family dr had not given them my 2 yrs of weight related office visits. Aetna gave me an approval in 30 minutes!

My problem w/Aetna is they require a nutritionist 3 visits and psych eval.....but with my policy they do NOT cover that expense.:thumbup: I"m looking at $500 psych bill & going to fight to get it paid.

[Sharontrek 0]

I am with Aetna and have jumped through hoops for the past 6 months. It was totally worth it but now I am a nervous wreck. I have one final visit with the dietician on Monday before it can be submitted. My problem is that they require a 2 year weight history. I am missing 2007's weight. Does anyone know if they consider 2 years to be an actual 24 month period or if I have documented weight from both 2008 and 2009 if that would suffice? My BMI is in the high 30's and I was diagnosed with sleep Apnea. If anyone has a similar experience, I would love to hear from you.