As of friday the 32st, the have changed there clinic policy and are now covering the band...WHAHOOOO. Hopefully now my appeal will go through with flying colors.....................

I have Aetna pos ins (since this Jan) and was told my fills are 175.00 and they dont cover them

I was really upset because we had UHC ppo and I got surgery then Dell changed ins choices and none of them said on phone they would cover my follow up apts...So I sure hope atena starts paying the bills :Banane33:

I went into the office last week and was told by the staff then that AETNA is now covering the lap band. I have to prove that I have been under a DRs. care for the last six months, and that DR. has had me on a weight plan. I am going to my family Dr. tomorrow, as she has had me on a plan for longer then that.

I have one more question? How long once all the paper work is done does it take for rejection or approval?

Thank you all for your time, I just hope I am one of the lucky ones!!!! :usa2: :usa2:

GOD BLESS AMERICA

haloep,

I just had my first consultation with a surgeon. The same day they sent in all the info including the diet documentation. Now the office is just waiting to hear from Aetna on what else is needed. I'm now officially on the waiting side of approval.

Aetna called my doctors office today, we were just getting ready to file the appeal since I was denied before the policy change, AND OUT OF THE BLUE AETNA CALLS TODAY AND SAID i"m APPROVED!!!!!!!!!whahoo!!!!

rroswell, that is so great to hear! Did you have complete the Dr. approved weight loss program?

I had 4 months when first submitted but the denied based off of there clinical policy, and have now overturned it due to the change..

INTERESTING.....I am in week 5 of pre op classes that my surgeon has all of his patients take and have not been asked to do the weightloss program yet(I'm sure it is coming). My paperwork was submitted to Aetna last Tuesday and I am now playing the waiting game.

I am very happy for you and wish you much success on your journey!:clap2:

Good Evening all. They have submitted my insurance for my lap band today. I am so keeping my fingers crossed. They were a little worried about the 6 month diet with a doctor. I had one for 4 months with one doctor and I was diagnosed with NASH, which one of the factors is overweight, and if I don't lose weight, then there could be complications later down the road.So plese all say a prayer and keep your fingers and toes crossed. They said we should know in about 30 days.

Haloep

I was also diagnosed with NASH. Plus Type 2 Diabetes...etc. I was all ready to go up against Aetna for approval but I've recently been told that it's my employer that put this on the plan exclusion list. I feel like I have hit a brick wall going 250mph now. I have emailed my corporate benefits dept and am waiting to see what they say I can do from here, if anything? =(

Hi All,

My corporate benefits dept replied to me today....our company plan contract does not include the surgery under any circumstances.

I'm SO disappointed but not ready to give up yet. I just don't know where to go from here. Any suggestions?

Get an attorney to write you a letter................Get him to review your health insurance benefits first. He can find a loop hole if he is a good attorney. It does cost them more to fight than just pay it.........

Find out who will handle your case and call them and start a relationship with them.... build repore........

Ok.....I've been denied for the 2nd time by Aetna. 1st time as not covered by plan and this time as not medically necessary. I read the medical policy before I even started all my leg work. My surgeon sent in records for 6 months of supervised dieting, my BMI is 48.9 and I have 2 co-morbidities. What else am I missing?

How I read the policy was that you only needed a psych review if you had a sever psychosis or such, and that you needed to see a dietician only if you had not completed the supervised diet for 6 months. Grrrrr....this is so frustrating!

I have Aetna also and they wat a 6 month diet supervised by a dr. I have tried several diets on my own and never lost much only to gain it and then some all back. ( Weight Watchers, Adkins, etc) Also was on phen pen under a dr. supervision, lost that weight and gained it back when they took it off the market. I'm tired of trying and will not be set up to fail again on a 6 month diet. I most likely would loose a minimal amount of weight and wind up re-gaining it which probably would mean another year before they might consider it. No certainty of that. So I may just have to do the 11,000.00 self pay.

pbrown,

Where do you do the $11,000 self pay? I just found out I was denied today from Health Net. I'm hiring an attorney as well. My surgeon is putting in the appeal as well. I am so angry. How dare these insurance companies think they can get away with this.

Good Luck.

Emily

Hi Emily,

My Dr. quoted a price of $11,000. for self pay and this price includes your after care and fills. This is through Dr. Avilla in Blackfoot, Idaho. They also are just now doing this in Idaho Falls, Idaho, but I don't know of the price.

Good luck!