Please help me!!

Hi,

Has anyone had trouble getting approval by Aetna for the band surgery?

I have a BMI of 46.8 and have a hurneatied disk in my lower back which I have received therapy for over 3month period on two different occassions. I have migraines.

I have been overweight for more than 10+ years. Tried phen phen and lost 100 lbs. 2 years ago , but then they took it off the market and I had to quit it and over the years my weight came back plus 80 lbs more after having my second baby.

Then the doctor tried me on phentermine alone and it did nothing. I need to lose the weight as I have a family history heary problems and high blood pressure. Wonder if this is enough info for them to consider me for coverage.

I need to see a surgeon that would do the banding and have done some research on this. So I need to find out if Aetna will cover this surgery?

So if anyone has anything that can help me that would be great!

Thank you

Hi,

I have Aetna (HMO) and was recently approved for a band. I was required to have had 6 visits over the past 2 years with my primary doctor which were focused on my weight and 3 of the 6 had to be in consecutive months. I think that since your BMI is greater than 40, you don't need any other medical co-morbidities. I'd do some reasearch online on Aetna's web-site, and see what is required for your particular plan. My experience with them was surprisingly pleasant, and I am having surgery next week. Good luck!

Hi, I was looking around for others that have Aetna and found your blog. Did you end up having your surgery? I have Aetna HMO. My BMI is 45 and I have about 80 pounds to lose. I was told that I need to show that I have been on a supervised weight loss program with my primary care physician and a dietician, and then they'll approve. I'm just starting this 6 month journey, but I did go to the surgeon's office and met with the staff there. Let me know how it goes with you. Good luck with it all.

Noosh

Hi Noosh,

I did have my surgery on 12-29-08. It went well, and although the incision where the port is was a little more painful that I expected, it hasn't been bad at all. I've lost about 15 pounds (not surprising, since there's not a whole lot that i can eat!), so I've got about 60 more to go. The first week was a little rough, between some pain (though not bad) and wanting to eat. Since then, it's been easier. I will be getting my first fill on 2-11, and I am looking forward to being able to eat real food again soon. As far as the process went with Aetna, it was really painless! The insurance guru at my surgeon's office did basically everything, and the fact that I had been seeing my primary care physician for about 6 months (and had 3 consecutive monthly visits...make sure you get those done) and had tried other way to lose (Meridia, Pfen-Fen, Weight Watchers, etc.) really helped. My out of pocket expenses were about $2000, including my co-pay and the classes that I took through the Bariatric Program that works with my surgeon. I've submitted the fees for the program to Aetna to see if I can get reimbursed, so we'll see how that goes! Good luck to you, and if I can do anything to help, please let me know!