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Aetna PPO

Mamaz2ndbaby

By Mamaz2ndbaby, in Insurance & Financing

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BrooklynBandster    0

BrooklynBandster
Posted

Hi, all - did those of you who did the three-month supervised diet (like pinkyinforney and jeejee) get monthly documentation from your doctor, nutritionist, and psych? jeejee, i know you said you didn't use a trainer during that time - did your doc just write down that they had placed you on an exercise program?

thanks!

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vallin    0

vallin
Posted

Hello, I am new and not too great at this message thing, my paperwork was sent to Aetna on this past Monday 07/23/07 . I did the 3 month diet AGIB in DFW had it together they have on staff a exercise counslor and a NP that counted as diet and exersize then within 3 days of that I had to go to a nutristionist. On my second month I went to see the shrink that was great becasue she also had the band for 3 years. I am just waiting for a reply from the insurance. I hope this works I have three kids and it was alot of sacrafice jumping thru the hoops. The key thing with Aetna besides the visit is BMI of 40 for the last five years or 35 with a health issue. Sorry for rambling,, :ranger:

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mjsafari    0

mjsafari
Posted

My husband and I were both approved by Aetna PPO - so there is hope. Remember though that your employer may be setting the rules for each surgery and can even exclude it, so as someone else mentioned, you may want to get your HR involved.

I think what helped me the most was a letter from my GYN. If you don't see a family doc regularly, but you see your GYN every year - ask them for a letter of recommendation and have that chart sent over. She had documentation on all my fertility and PCOS issues as well as a annual weight.

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NanaRenan    0

NanaRenan
Posted

Got the call at 9 AM this morning!! This was our 4th and last appeal.

Hallelujah!!!

They wanted to schedule me for Tuesday, but that's my GrandDoll's birthday, so I chose Thursday!!

I've already done pre-pro-op today.

1000 calorie/day liquid diet from now until then

Monday I get fitted for my CPAP

Wednesday I go back for more pre-op stuff

THURSDAY I get my band!!

I'm still in shock and still half afraid I'm gonna wake up and its all been a dream!!!

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MissNilsa    0

MissNilsa
Posted

Anyone had any problems with their surgery being covered by Aetna? Any restrictions etc?

Oh my god yes. I had major major problems with Aetna. They denied me and I ended up having to write my own letter (with my doctor's signature). He signed my letter which was brilliant and I got approved after my letter.

What about you?

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NanaRenan    0

NanaRenan
Posted

MissNilsa, did Aetna tell you why they denied you the first time? And what did you include in your letter of appeal that convinced them?

On our fourth and last appeal, my doctor's office specifically requested that my appeal be reviewed by someone with experience in bariatric surgery. After four "No."s we got approved. And with urgency, like -- get it done ASAP!

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KtKt    0

KtKt
Posted

I'm expecting the 6 month wait... and will use the time to my advantage, losing what I can before banding...

I think I've shredded my weight watcher stuff... totally ashamed of my progress there! Stupid me....

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vallin    0

vallin
Posted

Happy for you Nana!!!!! I live in Texas and have Aetna pos I should have a anwser by the end of th week!!!!!

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NYGMEN    0

NYGMEN
Posted

Congrats!! I should know 100% today. They sent me for pre-op already so i have hope it will happen

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NanaRenan    0

NanaRenan
Posted

If you have ANY co-morbidities and see specialists for them, make sure that THEY have done every test or procedure and have cleared you for surgery.

I was literally five minutes from being on the operating table when the anesthesiologist discovered there was no clearance document in my folder. His office was contacted and because he was out of town and my file there showed I'd never done a nuclear stress test that he mentioned once MONTHS ago....they couldn't authorize it.

I was told to get dressed and go home.

I was SO disappointed -- and I wouldn't want that to happen to ANYONE!

So please make sure!

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NanaRenan    0

NanaRenan
Posted

Oh, and btw--I've only got a couple weeks clearance and my approval by Aetna could 'go away'!!!:)

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vallin    0

vallin
Posted

Nygmen so sorry:omg:. Were you trying to get Aetna to approve under the 3 month multi diciplinary diet?

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Go To Topic Listing Insurance & Financing

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