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Impatiently waiting for Aetna



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Does anyone out there have Aetna? I have a BMI of 39.4, but still waiting to see if I have sleep apnea. I've completed all other requirements for surgery. Does anyone else have Aetna? Were you able to get approved? So frustrated and ready to go! Treatment shouldn't be dictated by my insurance, it should be dictated by a doctor! Grrrr!

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If your employer opted to cover the surgery, you shouldn't have any problems. You might want to call your network provider and find out the staus, it couldn't hurt!

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My employer plan does cover the surgery, I'm just worried about the long list of requirements that Aetna has. I haven't been at 40+ for two years and I don't know if I have sleep apnea

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I have Aetna and was approved. When my case was submitted, my BMI was exactly 40. I had none of Aetna's listed comorbidities (diabetes, sleep apnea, high blood pressure, etc). Nor did my weight history indicate a BMI of 40+ for two years. (It was 40 one year and 38 another.) I do, however, have sever osteoarthritis/degenerative joint disease in my knees because of years of being overweight. My orthopedist wrote me a letter of medical necessity for surgery. Additionally, I wrote a personal narrative and had it included in my file that was submitted to Aetna. My narrative/letter detailed my lifelong struggle with weight from my earliest memory at age 5. It chronicled every diet I'd ever been on, including my first Weight Watchers meeting at age 8, and Fen-Phen/Redux at age 16. When the Aetna nurse called me, she said, "I read your letter and wanted to tell you myself that you're approved."

I was told by the bariatric coordinator at my surgeon's office that approval really comes down to whoever is reviewing your case. Luckily, I tugged on that nurse's heart strings. My story was a compelling one that outlined my family history and my plea to not be another broken branch on that tree.

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That's what I'm hoping for. I've struggled with my weight from as early as age 6. I remember being "different" as early as kindergarten. Both sides of my family have a history of obesity, and health related issues due to obesity. I haven't had a chance to get married and become a Mom yet. I want to be healthy, so I can live long enough to raise my children. I don't want to die. This surgery will allow me to start a whole new chapter of my life as a healthy person with energy. I'm really hoping my insurance will give me that chance

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That's what I'm hoping for. I've struggled with my weight from as early as age 6. I remember being "different" as early as kindergarten. Both sides of my family have a history of obesity' date=' and health related issues due to obesity. I haven't had a chance to get married and become a Mom yet. I want to be healthy, so I can live long enough to raise my children. I don't want to die. This surgery will allow me to start a whole new chapter of my life as a healthy person with energy. I'm really hoping my insurance will give me that chance[/quote']

I'm in the same boat, sounds like my story. Wish you the best of luck. I'm doing a sleep study this week, guess we will see. The insurance approval process is draining. It shouldn't have to be this stressful.

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Sounds like we r all in the same boat! I have my second sleep study on 10/1.. Your absolutely right it should not be this stressful! I feel like my life is on hold....uggghh

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Wow I didn't think they could deny a sleep study.. I never thought I had sleep apnea turns out I have severe sleep apnea... Hope you can get your study!

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They denied my sleep study so I'm on a waiting period to see if I can get the at home sleep test. They should call me this week' date=' or I'll call them :)[/quote']

They denied my sleep study too, after they were the ones who ordered it. I am going to have the at home one this week. It's just so frustrating!

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Sounds like we r all in the same boat! I have my second sleep study on 10/1.. Your absolutely right it should not be this stressful! I feel like my life is on hold....uggghh

So now you have to have a second sleep study? Why?

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The first sleep study that is done is just to see if you have sleep apnea or some kind of sleep disorder depending on the results if you have severe sleep apnea they do a study withe the CPAP machine and I'm all for it the more severe the better my chances of an approval I'm hoping! Since I don't have the 2 year history they require.

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The first sleep study that is done is just to see if you have sleep apnea or some kind of sleep disorder depending on the results if you have severe sleep apnea they do a study withe the CPAP machine and I'm all for it the more severe the better my chances of an approval I'm hoping! Since I don't have the 2 year history they require.

Okay I see. That makes sense. Did you do a at home sleep study the first time? Did you think you had any sort of sleep problem before the study. I'm just scared I'm going to get denied because I may not have sleep apnea. My surgery is scheduled for nov 19th but aetna keeps ordering more tests. The surgery center has been doing all the communication with the insurance company so I am feelin a bit lost. Maybe I should contact them myself? I have read a lot of people submit their picture with a little personal information to personalize their profile.

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Your way ahead of the game if you already have a surgery date! That's awesome.. My sleep study was done at a sleep center I would have never thought of having a sleep study if it wasn't for this procedure.im hoping to submit my appeal again by 10/5 ... I so want to get this surgery this month or November. I would definitely call with a sleep study they have your results the next day.

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Your way ahead of the game if you already have a surgery date! That's awesome.. My sleep study was done at a sleep center I would have never thought of having a sleep study if it wasn't for this procedure.im hoping to submit my appeal again by 10/5 ... I so want to get this surgery this month or November. I would definitely call with a sleep study they have your results the next day.

Well I hope you the best. I dont know how the appeal process works but it shouldnt be this difficult for us. If we meet the insurance guidlines they should comply. I'm not sure how I got the surgery scheduled but now aetna wants the sleep study so it's still all up in the air. Let me know how it goes!

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