Insurance Question

[TxCoon 9]

I have decided to have the gastric sleeve done. I have Aetna HMO insurance. Has anyone else had this and got an approval? If so, how long and what was the process. Thanks in advance

*Aetna hmo

[TxCoon 9]

Anyone??

[Chele H 427]

I have Aetna Managed Choice. But, it doesn't matter if someone has the same insurance company or plan as you. You need to call Aetna to see which coverage your employer has chosen, what is covered and what the requirements are.

I had to have a history of obesity with no long term weight loss success and a letter of recommendation from my primary doctor. 3 consecutive monthly visits with my surgeon, psych visit, nutritionist visit, gallbladder ultrasound. But....I am not sure which of those requirements were Aetna' s and which we're my surgeon's personal requirements.

If you have already chosen a surgeon, he or she should have an insurance coordinator to help you through the process but the first step is to call Aetna. Get the first and last name of the person you talk to or ask them to assign reference number to the phone call and then ask or the weight loss surgery requirements in writing.

Good luck!!!!

[TxCoon 9]

I understand and know that. I was just wanting to know others experiences. Thanks.

[toyamurrell 6]

I dont have Aetna but I've seen alot of people on here get approved with them faster n more than BCBS.

[TxCoon 9]

That would be fantastic lol. I'll be calling tomorrow to see what info I can get. Thanks for responding

[majorsmama 91]

I have Aetna but not an H.M.O. I had to do 90 days of medically supervised weight loss which I did at my surgeons office, with their nutritionist. Once I had completed the 90 days, a psych eval, and EGD my insurance submitted my claim and it was approved by Aetna within 2 days. My surgery is July 29th.

Edited July 12, 2015 by majorsmama

[TxCoon 9]

Awesome! Good luck with your surgery ❤️

[Jersrose43 837]

What I know of Aetna I would sincerely caution you to stick to the strict guidelines

I've seen a boatload of posts here where people had a NET gain from the first day weigh in to when they went for approval of like 2 pounds and been denied.

Search Aetna in the posts you will see many folks were denied for gaining weight. Be mindful of that.

[TxCoon 9]

I searched Aetna and found a lot of quick approvals. I only seen one denial. I'm hoping for the best

[Jersrose43 837]

Look in the insurance forum. You will find a lot more than that

[khaled 23]

-40+ BMI with three months supervised diet .

-or 35+ BMI with diseases related to obesity plus three months of supervised diet.

-Psychological evaluation.

- and some other routine stuff

Usually takes from two weeks to one month to get the approval or denial. It took one day for me to get approved.

My surgery is on July 16th

[Jersrose43 837]

Look at this thread. Be careful of weight gain.

Again search the entire board not just one forum.

I went to gastric sleeve the. Insurance forum

http://BariatricPal.com/index.php?/topic/332570-Very-nervous-about-Aetna-weight-gain

[muzical1 85]

I was approved in 10 days.

[TxCoon 9]

Awesome! Congrats you two! Thanks for responding