Hey everybody!

For all of you pros out there. I currently have health net *** through my husbands work. I started my six months supervised diet in may.

He just notified me that in september, we will be switching to Aetna *** . I am so super worried that they will say " hell no" to me when I begin the process with them. I'm affriad they will want me to be insured with them for a certain amount of time before I can have surgery.

My question is, has anyone ever had a switch in the middle and was able to pick up were they left off?

Does anyone know if I have to be insured with my new provider for a certain amount of time before I can be approved?

I have this weird feeling of disappointment. Thank you all for your replies and opinions.

Some insurances do require that, someone else was asking about this. You can always have him ask his employer if they have a number you can call for new benefit questions. Often it is dictated by the employer.

There are lots of different forms of Aetna. Just as I started this journey, my husband got a new job. So I had the choice of staying with Tricare standard or going with Aetna. Turns out that Tricare does not cover the sleeve and that was what I wanted. As soon as he signed up for Aetna, I started jumping through their hoops. They did approve me but on my plan they only pay half. I think some of the things you are doing now will fulfill some of the Aetna requirements.

Khy

The supervised diet should be good no matter what. Just keep your records, and definitely call your new insurance. Tests are tests unless they want like a specific surgeon.

Hey everybody!

For all of you pros out there. I currently have health net *** through my husbands work. I started my six months supervised diet in may.

He just notified me that in september, we will be switching to Aetna *** . I am so super worried that they will say " hell no" to me when I begin the process with them. I'm affriad they will want me to be insured with them for a certain amount of time before I can have surgery.

My question is, has anyone ever had a switch in the middle and was able to pick up were they left off?

Does anyone know if I have to be insured with my new provider for a certain amount of time before I can be approved?

I have this weird feeling of disappointment. Thank you all for your replies and opinions.

I had the same thing happen last year. I had started with cigna. Half way through process insurance was switched to United. I was completely freaked out. However, it all worked out better than with cigna. I had my surgery on July 13 and my daughter is having hers on the !st. It covered both of us. You just have to make sure your Dr. is a provider as well as the hospital he operates. Good luck!!!!!!

As soon as you can make sure that bariatrics/sleeve aren't excluded. WHen you change companies, you're also changing plans, and there can be major differences.

Tests, diagnoses, etc. should be good universally. Those are done by doctors, not insurance companies, so they just don't matter in the same way.

Being able to start where you left off - in some ways, probably not in other ways. I don't know your status under your current insurance, but if you're pre-approved, you will not be pre-approved under your new provider, and they may have different criteria for approval (if it isn't excluded).

Re: waiting periods -- there are two kinds. Well, three, but two that might apply to you. Not all companies/plans use them, but more and more are starting to.

1. Employer waiting period - required by the employer before your benefits kick in. Usually less than 3 mos.

2. Provider waiting period (also called "affiliation") - required by the provider, but not the employer. I think these are only in force with HMOs. Cannot be longer than 3 mos.

You'll want to look into it asap.

Make sure you keep records of progress so far--diet, labs, consults, etc. Also, your first concern is potential exclusion of bariatric surgery in the new plan--find that out asap.

I didn't switch insurances but I do have to wait 1 year of being employed before my insurance would cover the VSG.

Good luck!

Wow! All great information.

So far I have only seen my pcp and the dietician. In went to a seminar but never got my referral to see him. I haven't even decided if I wanted him or not. I haven't had an approval yet.

I will have an appointment in aug with my pcp. I have to wait till septemebr to ask for a referral.

How did you all get to meet with your surgeons? When did you get your referral?

The only records I have are my meetings with the dietician and my monthly weigh ins.

Thanks for giving my hope everyone.

Natasha

I called to make an appointment and requested to speak with the surgeon about my candidacy for surgery.

Hey everybody!

For all of you pros out there. I currently have health net *** through my husbands work. I started my six months supervised diet in may.

He just notified me that in september, we will be switching to Aetna *** . I am so super worried that they will say " hell no" to me when I begin the process with them. I'm affriad they will want me to be insured with them for a certain amount of time before I can have surgery.

My question is, has anyone ever had a switch in the middle and was able to pick up were they left off?

Does anyone know if I have to be insured with my new provider for a certain amount of time before I can be approved?

I have this weird feeling of disappointment. Thank you all for your replies and opinions.

I started my 6 months supervised diet back in February, so my last month is July...my company was sold July 1st and we have new Insurance as of July 1st which is Aetna

I had completed all the requirements was submitted to Aetna July 25th was approved on July 28th. So I think as long as you meet their requirements I don't think you will

have a problem,,, I

I had started my pcp supervised dieting last Sept By Dec, I had had the dietician consults and psych eval completed. My clearances with cardiologist and pulmonologists were also done by this time, however, I had to wait until Feb of this year to really push for getting surgery because that was when my 6 month period ended. Fortunately, I switched surgeons after having a miserable experience with the first surgeon--by a stroke of luck the ins referred me to the doctor I had originally seen in 2007 for the same problem--regained weight, and how to fix the bypass I had in 2001.

I have been on welfare and state Medicaid due to economic hardship. My surgery is covered through Medicaid, and I have followup care after my surgery 2 months ago. I feel swell! Have lost 30 pounds and continuing on the path of good health and wellness for my lifetime. I am so lucky!!!

Why do you have to do the six month supervised diet with Health Net? I have them also and that is not a requirement for the sleeve. Go look up their National Medical Policy - they no longer require a six month supervised diet for any WLS.

Yep - just checked to be sure. Their National Medical Policy was updated in Sept 2010 to no longer require participation in a supervised diet program prior to approval.

Your doctor might require it, but Health Net does not.

The only requirements for a sleeve from Health Net are:

BMI higher than 40 OR BMI higher than 35 with a severe co morbidity.

Less than 65 years of age.

You must be able to show them that a gastric band (lap band) or a gastric bypass will not be appropriate for you (ie...stomach/bowel issues, taking anti inflammatory meds, etc).

That's it. No supervised diet.

I had started my pcp supervised dieting last Sept By Dec, I had had the dietician consults and psych eval completed. My clearances with cardiologist and pulmonologists were also done by this time, however, I had to wait until Feb of this year to really push for getting surgery because that was when my 6 month period ended. Fortunately, I switched surgeons after having a miserable experience with the first surgeon--by a stroke of luck the ins referred me to the doctor I had originally seen in 2007 for the same problem--regained weight, and how to fix the bypass I had in 2001.

I have been on welfare and state Medicaid due to economic hardship. My surgery is covered through Medicaid, and I have followup care after my surgery 2 months ago. I feel swell! Have lost 30 pounds and continuing on the path of good health and wellness for my lifetime. I am so lucky!!!

You really are lucky!

Amazing story. Thanks for sharing.

Why do you have to do the six month supervised diet with Health Net? I have them also and that is not a requirement for the sleeve. Go look up their National Medical Policy - they no longer require a six month supervised diet for any WLS.

Yep - just checked to be sure. Their National Medical Policy was updated in Sept 2010 to no longer require participation in a supervised diet program prior to approval.

Your doctor might require it, but Health Net does not.

The only requirements for a sleeve from Health Net are:

BMI higher than 40 OR BMI higher than 35 with a severe co morbidity.

Less than 65 years of age.

You must be able to show them that a gastric band (lap band) or a gastric bypass will not be appropriate for you (ie...stomach/bowel issues, taking anti inflammatory meds, etc).

That's it. No supervised diet.

OMG! I could die. My six months would end in septemeber any way. Now that I'm switching it will be effective September 1 st. With Aetna.

Aetna wants 3 months so I'm hoping it just rolls over and I can get approved.

Thanks.