lilbit08

I have Aetna Open Access they do require medical records for the past 2 years showing obesity. A six month diet and exercise program through your doctor, 3 months have to be consecuetive (sp) in the last 2 years. Lower BMI's require co-morbidities.

Here is a link to the policy

Obesity Surgery

As long as your employer did not exclude the surgery you should have good luck.

Personally, It took less that 1 week for me to be approved for my surgery, but I knew the requirements, and had done everything on the list, except the surgeons required pre-op tests & nutrition, before we submitted.

Julie

Sent u a private message. Thanks!

Aetna's bariatric policy is on their web site so you can look up the details. They do pay for lap band if your BMI is over 40 and you go through a 3 or 6 month program. However, your company has to include WLS in their coverage. If your company excludes it, then you are hosed.

Hi there! Thanks for the reply. MY BMI is 49.1 but I am not sure that the policy is going to cover me. I have my consult on 1/6 and I was told that the Dr ofc that I am using is good about trying to get approval, so we will see. How would I know come Jan if my job's policy totally excludes wls?

:smile2: Ok...So I was so excited because I was scheduled for my consult on 12/4 with my current insurance of Cigna's Open Access Plus Plan. This is my very 1st step in starting the whole weight loss process. A while back when I called them they told me that WLS was excluded unless medically necessary and I have a BMI of 49.1 so I am thinking that I was going to be ok.

Well I get to work on Monday to get an email from HR that our insurance as of 1-09' is going to be changed to Aetna's Open Access Plus Plan. I called the Dr's ofc and they moved my consult day to 1/6 because the scheduler stated there was no reason for me to come in on 12/4 and they try to get approval thru Cigna when in January it is changing. Just wondering if anyone has ever used or known anyone to have Aetna's Open Access Plus Plan pay for the lapband? If so, Please let me know the process! Thanks bunches!:wink2:

any other 30's in there that have had the lapband and doing well? any 30's in here that have had the lapband and not doing sooo well? please shed light as i am trying to decide between the lapband and rny....:thumbup:

Are fills paid out of pocket? If you have insurance does that normally cover the fills if it covered ur procedure? I don't understand the whole fill thing. Also, how many fills do u have to get?:thumbup:

Ok in the past I have studied the VSG procedure which was my surgery of choice but I am trying to use my insurance and they dont cover the VSG. I am stuck between the lapband and the RNY..I am sooo scared of the lapband...It is because I have heard sooo many stories about slippage, erosion, revisions, failures etc..that I am not sure that I want to go thru all that. My husband doesn't want me to have any WLS but stated that if I just had to have one then he would rather me go thru with the lapband because the RNY is too complicated...I am so terrified about foods getting stuck, terrified of PB-ing and vomiting....Is this normal??:thumbup::ohmy:

well i called the ins co and they told me that wls was excluded but that if medically necessary it cld be approved...soooo i have a consult on 12/4 and the dr that i have chosen they say are good with getting u all u need to be approved..we will see

I have the same type of insurance as you. You will have to do a six month diet if you haven't already. They now accept weight watchers, jenny craig, etc, they didn't when I was trying to get it approved. If you have done any of those diets, get the records. If you haven't had the 6 months, start on it now. You will need it before they will even consider it. You will also need a psy and nutrition eval. Your PCP will also have to write a letter of medical necessity. The doctor needs to put any comorbitites you have in the letter as well as how long you have been overweight. I think they require you to have been overweight for 2 years. As far as losing weight on the 6 month diet, they want you to lose so much percent, I can't remember the exact amount. I was lucky that my surgeons office helped a lot with the paper work. Once everything was submitted, it didn't take long for me to be approved, about 3 weeks. I haven't had any problems with them so far. Good luck!

thanks for the reply..so let me understand..ihave done weight watchers in the past but not for 6 mnths...the dr that i am using, i have been told that he is pretty good with helping u along the way..i know that u said they make u do a 6 mnth diet first, so how did u get approved in 3 weeks?

I was told by a Cigna rep that all WLS surgery was excluded unless medically necessary. I currently dont have any health problems except anxiety and depression but I do have a BMI of 48. I also took my 1st step and scheduled my consult for 12/4..I am sooo excited.:smile2::cool2:

This article is worth a look to help you get the approval the first time:

http://www.obesitylaw.com/images/content/pdfs/Maximizing_Article.pdf

What I had to do was fill out this really long packet of info and then go to the Dr. and have them weigh me. Unfortunately most PCP aren't clued in about what to put for notes for this kind of surgery. I was supposed to go for 6 months. Well then I was denied. I wish I had read the article above. You may not have all these requirements but your Dr. office once they get the packet may be able to help more.

Hopefully someone with the same kind of ins. will chime in. I have PPO but I thought I would at least reply with that article. Good luck!

M

Thansk for the info! Looking over it right now!

Ok I have Cigna Open Access Plan and I called them today and the rep. told me that my policy doesn't say whether it covers WLS or not. He said that whatever Dr. that I choose would need to call them and get Pre-Determination of Medical Necessities paperwork, fill it out and send it back in and then we can go from there....Anyone know what this means? Also, what is the 6 mnth period that most ins co's make u do and what if u loose weight during this time? Does it mean you are no longer eligible for ins to cover u? Someone please advise...

I recently started a new job and as of 11/14 Cigna is going to be my insurance company. I have heard good and bad about this insurance when it comes to WLS. I have the Open Access Plan and was wondering has anyone ever had Cigna to cover the lapband? I am not at all interested in the Gastric as it seems to be covered by more insurance companies. My in-network is 100% so that is good! Any advice?:biggrin:

Thanks!:sad:

ok thanks..good idea!

well the problem for me getting financed is that my husband and i both dont have any credit and the credit that we do have is just not the best.....soooooo i was hoping that cigna would cover the procedure once the new hire 90 day probation is over.

wow...didnt think of that..how do u do that???

i was trying to get financed for the vsg procedure and had hell because i dont have any credit. let me know who helps u as i think i have tried all companies possible in america and was denied!

wow..thanks for the info! ur's went well. i dont have any of the insurance info as of yet except that it is cigna and that is all i know...i will try and find out more at work, but i dont want to ask too much to where i am letting them know that i may try to use the insurance for WLS. some companies dont like that from what i hear.

i had lots of problems getting financed because i didnt have any credit when i was trying a few mnths ago to get financed for the vsg procedure. any ideas?

wow...thanks soooo much! hopefully i get more replies also.

Can you tell me who u think is a good Dr. In the DFW Area that performs the lapband and why? Also if you know the total cost that would be great as I may have to be a cash pay...

Thanks ahead of time!!:thumbup:

Thanks I'll keep him in mind!

can someone please shed some light and tell me who some good dr's are in the dallas area that perform the lapband procedure? if you know the cost too, that would be great because i am thinking that i am going to be self pay...:party:

thanks soo much for the replies. hopefully sooner than later i can get my process started!:thumbup:

:smile2:hi to all! i am not new to this website,but i am back to this website. i was looking into the lapband and then i decided after studying the vertical sleeve gasterectomy that it may be a better option for me. i had lots of problems trying to get the money to finance the procudure because i dont have enough credit to get a good loan amount. it stressed me out so bad that i have decided to chill and wait for a while but in the mean time, i am thinking about the lapband again because it is reversible and the VSG is not....if u can, please shed anything rather good or bad on the band and ur experiences with it so far..thanks! :thumbdown: