Hello there, my surgery is tomorrow (New Years eve!) and I have been up all night worried that my insurance approval will be overturned because I have gained weight since the approval several weeks ago. The approval letter states "The information provided above is not a guarantee of coverage. Coverage is based on all the terms and conditions of your plan as well as eligibility at the time services are received."

My Aetna plan requires a 90 day pre-surgery regimen, and states: "Records must document compliance with the program; the member must not have a net gain in weight during the program."

I lost weight during the program, but gained 4 pounds after the approval letter was received. Does anyone know if Aetna ever denies paying for surgery after pre-approving? Am I over thinking this? :-s

Thanks @@CountryGirl5584! That is reassuring to have it confirmed. I've yet to see a bill from Aetna (had my surgery on 31st Dec) so am waiting to wee wha it ends up being. :-D

You should get an explanation of benefit by valentines assuming hospital submitted timely.

You don't get a bill from aetna and please don't pay anyone anything until they send you an actual bill from the provider of service.

Don't pay based on the aetna EOB.

@@Jersrose43, wow, thanks for the feedback! I had no idea that it would take that long. That is crazy...but I don't mind waiting until I have to pay my portion. :-D

@@Jersrose43, wow, thanks for the feedback! I had no idea that it would take that long. That is crazy...but I don't mind waiting until I have to pay my portion. :-D

It can be faster but most hospitals take 5 days to submit. A little longer for inpatient.

The 5 days to process at insurance assuming that everything they need is there and that the contractual arrangement is simple. Most hospitals aren't

You can log on to aetna.com and watch your claims go through.