Aetna Sleevers - Share Your Approval And/or Denial Experiences Here!

[funkeechiggen 135]

My paperwork was officially submitted to Aetna yesterday, so while I am twiddling my thumbs waiting to hear something (an approval, HOPE-HOPE-HOPE!), please share your Aetna experience!

1. How long did it take for you to get an answer once your paperwork was submitted?
   
2. Has anyone with a high BMI and co-morbidities been denied? If so, why?
   
3. Do your ears hang low, do they wobble to and fro? <g>
   

[Raven21 121]

I'm hoping to have all my boxes checked by November 15th for submission.

The Bariatric center I'm using said they have only ever had one Aetna denial and it was because there were no doc notes to prove at least a 2 year history of obesity.

[Raven21 121]

On the phone, Aetna told me they are required to respond within 7-14 days, but it looks like some people get theirs sooner. Me, I hope! And you too!

[funkeechiggen 135]

OHHHH HOLY CRAP!!!!!!

NOT MORE THAN 15 MIN'S AFTER POSTING THIS THE INSURANCE COORDINATOR CALLED AND I'M APPROVED!!!!!!!!!!

WOOOOOOHOOOO!

[Bmarion662 76]

Curious how did you do on the 6 month physician monitored

[funkeechiggen 135]

Curious how did you do on the 6 month physician monitored

I did the 3 month track. I did OK but didn't really lose just maintained. In fact I was up 4 pounds at my last weigh-in but that's because of PMS. I usually fluctuate 4-5 lbs due to that. The last several weeks I have been drinking a Protein shake for Breakfast. As someone who never eats Breakfast this was hard to do but it seriously curbs the hunger pains. I've found that I don't eat a very big lunch when I drink a shake for breakfast. I will have to do a 2-week liquid diet before surgery. I think next week I will start drinking shakes for breakfast and lunch. That way it won't be such a shock to go from 1 to all liquid meals.

[Raven21 121]

Response in 24 hours? Seriously?

I'm on the 3 month track too. 90 days will be November 15th.

[Raven21 121]

I'm still in shock over your amazing response time.

If you don't mind me asking, did you have a BMI over 40 or did you have to document comorbidities?

[funkeechiggen 135]

I'm still in shock over your amazing response time.

If you don't mind me asking, did you have a BMI over 40 or did you have to document comorbidities?

I am still in shock myself... And just got off the phone with the hospital where I'm having my EGD done on Thursday morning. It's really happening!!!

BTW - My BMI is 45 and I have high blood pressure and sleep apnea.

[Bmarion662 76]

Glad to know Aetna responds qickly... Best wishes for you and yor sleeve!!!

[ebonisekim 1,713]

ThAts who I have and it gives me much hope

[funkeechiggen 135]

Even more good news this morning... It appears my surgeon has recently shifted from a 2 week liquid diet to 1 week. Soooo happy to hear that!

As far as the quick turn-around on the insurance approval, my insurance coordinator at the surgeon's office is well-versed on Aetna's requirements and knows many people in their approval department! I politely asked her to see if she could get an ETA on the decision time. She called me back within a couple hours and said "You're approved... What did I tell ya - I know people!".

So, moral of the story is:

1. Having a well-qualified team of insurance coordinators at the surgeon's office is important!
   
2. Being polite to your insurance coordinator is equally important
   

[Bmarion662 76]

Does this mean you will be sleeved in a couple of weeks

[funkeechiggen 135]

Does this mean you will be sleeved in a couple of weeks

October 25 is surgery date!

Start liquid diet on October 18!

[jusstice 103]

Well, not 1 day turn around, but my Aetna experience was just as good. Doctor's office submitted on 9/27. I phoned on 9/28, and they said check back Monday. I called Monday and was told they were waiting for some additional information. Called today and was told they approved it yesterday! I am so excited.

Must say the Aetna people I spoke to were all very sweet, helpful, and polite (then again, I was too). The pre-certification lady even transferred me to the Benefits people when I wanted to double check level of coverage (100% for both hospital & dr).