Anyone with Aetna Insurance ???

[Janiece 64]

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.

My BMI is 44 but I don't have an comorbidities. I just had weights from 08 and 09 too. I did the 3 month program and they approved me. Good luck!

[Sharontrek 0]

Thanks for the info Janiece. I actually decided today to switch surgeons because the insurance "specialist" that I was dealing with was not only unprofessional but just a real pain in the butt. The new clinic that I visited today was great! We decided that it may be a good idea to hold off until the first of the year in case they decided to give me a hard time about one of my two years being the current year. I am so happy to hear that you got approved. This is a very stressful yet exciting time for us all and I can't wait to actually get an approval. I really enjoy this site and reading about everyones individual experiences with the band. I look forward to following your journey. Thanks again for the info!

[aubrie 6]

I have had Aetna insurance since 1996. It was basically good and easy until I decided I wanted bariatric surgery...... then the nightmare started. Initially they told me no. Then I found out that they did cover it. I had to do a six month diet before they would even consisder me. 4 months into my 6 month diet, they told me it wasn't being documented correctly and I had to start over. I started over. Had it documented, and at the end of the properly documented 6 months they denied me. I appealed. They denied me again. I was LIVID. I cried for weeks. Then I decided, NO. I was not going to take that crap and then I got MAD.... My BMI was 43 so that was not the issue. I had a sleep study done. While I did not have sleep apnea, I WAS a heavy snorer with sleep disturbances. I went to a nutritionist and got a letter of recommendation. I went to my OB/GYN and got a letter from him stating the surgery would help with bladder control issues and ovarian cysts. I went to my Rhuemetologist and had her write a letter stating it would help with the arthritis in my knees, back and hips. I went to my internist who wrote a letter stating it would help with lowering my blood pressure and alleviate my depression symptoms. So appealed again armed with all that support. How could they argue? 11 months after starting the second 6 month diet I had my surgery. 15 months in all. I just didn't give up. ROTTEN SCOUNDRELS. To date I no longer need my bladder control medication, I don't snore and sleep soundly, I've only had one brief flare up of my ovarian cysts, I no longer get shots in my knees or take Celebrex, I no longer have high blood pressure, I don't take Wellbutrin for depression anymore and I've reduced the dose of my thyroid medication. How do they not see the benefit in all that? It boggles the mind....

Edited October 22, 2009 by aubrie

[HappyHomeCC 2]

I have Aetna choice POS II I found out today that I will only have to pay $850 for my surgery, and the fill appts are charged at a $15 office CoPay.!!!! I have a out of pocket max of $1500. And I have met $650 of that this year on other things! I have been impressed with how I have been treated and communicated with. The company my husband is employed with has its own patient advocate nurse, the one assigned to me has had bariatric surgery herself. She spent 1/2 hr talking to me making suggestions etc giving me pointers. I must say I have been happy thus far and I never thought I would say this but this insurance company rocks! I think it does depend what the employer is willing to put on their policies and pay for. I only had to do a 3 month supervised diet.

[HappyHomeCC 2]

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. I"m looking at $500 psych bill & going to fight to get it paid.

My Psych eval, Nut, other drs etc were all covered and paid only a $15 office visit copay. I am sorry you are getting stuck with that bill

[Sharontrek 0]

So I go to the dietician today and also meet with the program coordinator. She informs me that because I don't have a BMI of 40 and because I wasn't diagnosed with sleep apnea until this process that I would most likely be denied. Has anyone else had a problem with not having your co-morbidity for long enough? I'm not sure why they didn't tell me this before they sent me for the sleep study, to the cardiologist amongst the other doctors I had to go to. Why wouldn't they just tell me six months ago that I don't qualify. Instead they send me in search of a co-morbidity that they now tell me will do no good. Grrrr!

[claricey 65]

I have Aetna Choice POS II in the metro Philly area and just received my approval yesterday!

From the time my surgeon submitted all of my information to them it only took 7 business days to receive approval.

I did have to do all of the psych and nutrition work plus a 3 month program and my BMI is 47.

Good luck everyone!

Claricey :thumbup:

[BigMomma 0]

I got impatient and emailed Aetna and they never received my information. I emailed my center and they refaxed the info today and she later emailed me that I had been approved. :thumbup:

[claricey 65]

Congrats on your approval!!!! :thumbup:

[Yolly 0]

I have Aetna Choice POS II. I was approved in just 6 business days. I am so excited. Now the hard part is picking the best surgery day for this time of year. Any suggestions?

[HappyMe2009 0]

Hi everyone!

I am delighted to say that my denial was reversed and Aetna (HMO) approved my surgery yesterday!!:tongue2: I have a tentative surgery date of December 7th. It's been a "process" and very frustrating at times, but when I read that letter yesterday, all my woes have been worth it! Congrats to everyone who has been approved and to those that are in the appeal or denial process, KEEP PUSHING on... don't take their "NO" for an answer...

[KBertinelli 0]

Hello All- I just did my 12 weeks of pre-op have high blood pressure and pre diabetic havent done the sleep study yet and BMI is 37 and I was DENIED!!!! I am so bummed- I cried when I got the letter-PLEASE ANYONE WHO HAS APPEALED RESPOND AND GIVE ME SOME TIPS AND HOPE- tHANKS

K

:thumbdown:

[leroyspuds 0]

Get the sleep study ASAP - if you have sleep apnea you're in! That's what qualified me with BMI 37. Good luck.

[BandedShari2010 0]

I have Aetna and was just banded on 4/13/10. I had no problems with them, I did everything they wanted. I had a BMI of 43 with comorbidities. It was submitted on a monday and approved on thursday. My total out of pocket expense for everything since I began this journey was $2000.00. I am very happy with Aetna.

Shari

Edited May 14, 2010 by BandedShari2010
misspell

[JMA908 0]

I went for my appointment today and have Aetna. They said that is I make all of the appts. and do the nutritional consult for three months consecutively, I should have no problem. BMI of 43. I really hope it goes through!!! I am nervous, they told me not to worry.