Aetna Approved My Gastric Sleeve Surgery In Less Than 72 Hours!

[longer-life 139]

Wow, I never thought it would be this fast! I have to day it has been an easy process with Aetna. I called them a few months ago and they directed me to their "Clinical Bulletin" at "myaetna.com". Since it lists EXACTLY what they cover, there were no surprises.

Having an experienced bariatric center I am sure helped too. They provided my PCP with a sample letter of medical necessity and the document to fill out on every one of my (supervised diet) visits. The insurance coordinator also gave me a list of everything I needed to turn in.

I feel very lucky and happy tonight! There is hope if you have Aetna!

[Neese 75]

Im excited for you! I have Aetna as well so fingers crossed to a quick approval!

[longer-life 139]

Im excited for you! I have Aetna as well so fingers crossed to a quick approval!

Fingers crossed and good vibes! Best of luck!

[illgeturhairdid 176]

I have Aetna too! I'm happy to hear it isn't always a mess to get approved!

[longer-life 139]

I have Aetna too! I'm happy to hear it isn't always a mess to get approved!

That is precisely why I posted it. :smile1: It was super easy. Best wishes with your approval!

[Amanda131 214]

I also was approved within 72 hours and had a super easy time with Aetna. Just an FYI, they did wait a long time to pay one of my big bills (over $2,000) and that made me nervous but they did finally pay it. Now, I am hoping they'll be this easy when I am ready to dump some loose skin and try for a covered pannilectomy!

Best of luck to you guys!

Amanda

[klus263 9]

I also had Aetna but with self funded employer. I called the office on Monday the Nurse had just received all the paperwork and they were reviewing that they had all the paperwork before they sent it to the review board. I called on the Wednesday morning and it was just sent over that morning. I received the call from my doctor's office that afternoon at 2:00 that they were given approval and for me to pick my surgery date. It was almost too easy. My BMI was 38 but I was diabetic. Good Luck. I never regretted this and it was the best decision of my life (well 2nd to getting married to my husband).

[longer-life 139]

I also was approved within 72 hours and had a super easy time with Aetna. Just an FYI, they did wait a long time to pay one of my big bills (over $2,000) and that made me nervous but they did finally pay it. Now, I am hoping they'll be this easy when I am ready to dump some loose skin and try for a covered pannilectomy! :smile1:

Best of luck to you guys!

Amanda

Thanks for the FYI! What was the bill? Was it the nurse assistant or pathology? I found it strange the hospital made me sign separate papers for these charges.

Good luck on the panni, I am sure I will need one too!

[Veda 12]

My Aetna PPO 70/30 Plan does not cover WLS so I'm a self pay. So glad you got it approved!

[sabrina140 33]

I am sooooo happy to hear of all the good feedback for AETNA. I just finished my 6month 'nutritionist' appointments and am getting my paperwork/bloodwork done through my PCP.... I do have one question. For others that had to do the pre-approval supervised diet with Aetna, did you lose/gain during that time period?

Thanks a bunch! Sabrina.

[Tai29 17]

I just wrote a really long dissertation like response about panniculectomy and coverage in the section where someone started a tab saying "UHC covers plastic surgery"... I would say to check that out, but if you can't find it (I can't remember which section it was under) to briefly recap, the panniculectomy are a tricky thing to have insurance pay for. If you can believe it, most insurance companies have a certain measurement where the excessive should hang for example "more than 3 inches belong pubis" and you have to have recurrent/chronic skin infections that have been treated with multiple courses of oral medication i.e., tetracycline, and continued use of said medication w/ no improvement.

Because I know all of this... I'm planning on getting a good personal trainer to tone up as much as I can post op because panniculectomy coverage is a never ending roller coaster.

Best of luck!

[omamilam 11]

Hi,

I'm just starting the supervised thing. I went to my PCP doctor today and told him what the insurance company expects in order for the procedure to be covered by Aetna. He replied that he had never had to do that criteria before and the insurance companies know they are better off if you have the surgery so they don't get that technical. I told him I had just spoken an hour ago to the Bariatric Team coordinator and wrote down what I needed to do. He said the Bariatric office will do the 6 visits and I said they told me you would do them. All he told me was to cut down to 1500 calories a day and to exercise. The Bariatric team said the diet had to come from a nutritionist and exercise had to be documented. I am so confused right now.

Did anyone have problems like this? What happened? How do I get my doctor to comply? Who did your visits the PCP or the Surgeon? I am so frustrated!

Vicki (Oma Milam)

[Sammi25 18]

^{i also was approved within a few days with aetna i am 4 months out now and the bills are starting to come in and so far it has all been super reasonable aetna truely did a great job in my experience! good luck to everyone!!!}

[longer-life 139]

Hi,

I'm just starting the supervised thing. I went to my PCP doctor today and told him what the insurance company expects in order for the procedure to be covered by Aetna. He replied that he had never had to do that criteria before and the insurance companies know they are better off if you have the surgery so they don't get that technical. I told him I had just spoken an hour ago to the Bariatric Team coordinator and wrote down what I needed to do. He said the Bariatric office will do the 6 visits and I said they told me you would do them. All he told me was to cut down to 1500 calories a day and to exercise. The Bariatric team said the diet had to come from a nutritionist and exercise had to be documented. I am so confused right now.

Did anyone have problems like this? What happened? How do I get my doctor to comply? Who did your visits the PCP or the Surgeon? I am so frustrated!

Vicki (Oma Milam)

Call Aetna and have them direct you to the web page (Bulletin) that states the requirements, versus them dictating them to you. There you will probably see two options. One for 6 months and one for 3 months. I picked the 3 months with my primary doctor. My surgeons office provided her with the forms to fill out. I also went to see a dietician & a psychologist. Cant remember everything from the top of my head.

Does your bariatric office have an insurance coordinator? After I read the bulletin and picked a surgeon, the insurance coordinator called Aetna and confirmed what I needed to do. So we both checked. Do you have a surgeon of excellence? My bariatric office was very experienced and it saved me loads of headaches. I hope this helps.

[longer-life 139]

For others that had to do the pre-approval supervised diet with Aetna, did you lose/gain during that time period?

Thanks a bunch! Sabrina.

I have a great PCP. We came to an agreement that 1 pound a week was good and that is what I did. She always wrote I was compliant. hope this helps

Thanks Veda & Tai29

Edited November 20, 2011 by longer-life