Hello,

I am in the process of starting my journey. I have my first meeting with the surgeon on Sept. 26. I have Aetna POS I am really nervous that they are going to deny me. Can anyone who has gotten approved by aetna tell me in detail what they did?

Hey everyone , I was approved today! Aetna tried to give me a hard time.... but my patient advocate with the bariatric center helped push it through! My date us Nov 3rd

Congrats!! I'm hoping for the same results lol

@@nbw1220 I hope everything works out for you. Keep us updated.

I will ????

Ok so my paperwork wasn't turned in on 10/10 they ended up sending them on 10/15 so it still pending!! :-(

@@Ladiec2, it says in the requirements that you can do either six months or three months, depending on who monitors your weight during that period. My surgeon is a center of excellence and having them supervise my diet for three months was sufficient.

I did the 4 month condensed deal to get approved.

1. Met with PC once a month

2. Met with trainer once a month

3. Met with Dietician once a month

4. Met with Psychiatrist once a month

These were all required by Aetna to hopefully get approved in 4 months rather than the 6 my plan normally requires. I did all of it and got a call from a nurse at Aetna telling me that they didn't have a weight history from 2 years ago. I had 8 years ago, 10, years ago, a few months ago and last year...all making a perfect case for me as far as weight is concerned. Thankfully, I believe this nurse listened to me, took it to her director, and consequently I was approved. Had surgery a week ago Wednesday and so far it's been awesome.

Oh ya, you cannot gain any weight during this time or you will be denied.

Ok I got the approval today.. I have to call in the morning to get my surgery date.. It only took 3 business days!!!

Hello,

I am in the process of starting my journey. I have my first meeting with the surgeon on Sept. 26. I have Aetna POS I am really nervous that they are going to deny me. Can anyone who has gotten approved by aetna tell me in detail what they did?

Hey! First off, congratulations on even making the decision to go through with the surgery.

I have aetna and I got approved in September. My surgery is scheduled for November.

With aetna they required a 3 month supervised visit with the NUT & NP.

I started that in June. I also had to provide my highest weights from two years ago, have a psych evaluation, which was the most boring thing ever, and a sleep study.

Aetna'so policy states that you can't have a net gain...AT ALL.

So when I had a weight gain of about 2-3 pounds I wanted to give up. My NUT told me they would write an explanation in my reports for that weight gain.

My sleep study test came back negative...which was a bittersweet thing.

My only real health issue was that I was borderline diabetic and that I had been overweight pretty much my whole life.

I surprisingly got approved about two weeks after all my paperwork was sent in.

So Aetna isn't always the big bad wolf lol.

Good luck!

Edited October 21, 201411 yr by yungshi

and.... they're still pending! it's been three weeks since i've been submitted. i just got aetna to agree to have their nurse call my surgeon's office to try to facilitate this happening. i've been calling at least once a week. frustration! if i have to have my date moved back yet again i will scream. i'm so stressed about this i have been eating, and i don't want to lose this whole thing by ending up having a net gain. frustrating! so happy for those of you who are having an easier time of this.

and.... they're still pending! it's been three weeks since i've been submitted. i just got aetna to agree to have their nurse call my surgeon's office to try to facilitate this happening. i've been calling at least once a week. frustration! if i have to have my date moved back yet again i will scream. i'm so stressed about this i have been eating, and i don't want to lose this whole thing by ending up having a net gain. frustrating! so happy for those of you who are having an easier time of this.

I'm sorry it's taking so long but keep faith! Hopefully by this Friday you hear something positive! Wishing you the best

I know the waiting is hard. Do you have any idea what the hold up might be? I know I will probably be having the same issues when my time comes and probably will be calling every day. Hopefully you'll be hearing something very soon. Good luck!

i finally got the approval late Friday, by calling the insurance company.

now i'm waiting on the surgeon's office to schedule me. and, yes, i called them Friday and today.

one more hurdle....

I have Aetna, too. Should have been submitted last friday. How long should I wait to hear about approval? Should i call the hospital, or wait?

@@cube68, i would call the insurance company to make sure they got everything they need first. following up with them seems to be the easiest to do, and doesn't annoy the person in the surgeon's office by continually checking.

when i got the word from the insurance company that they were waiting for additional information from the doctor, THEN i called the surgeon's office to faciliatate them sending the additional info. then back to the insurance company, yada yada yada.

does it help to do all this calling? i don't know, but it made me feel better than just waiting.

Heard from the hospital today. Passed review board and insurance approval. Dec 3rd here I come.

I had an Aetna case manager (Nurse) call me. She asked a bunch of normal Dr questions and if i would have a driver, and support at home. Does this mean Aetna is going to approve me? Why would they assign a case manager to me if they were going to deny me? At least I know theyve received the paperwork....getting anxious. Any hints in what being assigned a Case Manager means?