Anyone else have an Aetna HMO? I'm in the middle of the 3 month process, has it worked out for anyone yet? Scared I will spend all this money in copays and then will get denied...

Anyone else have an Aetna ***? I'm in the middle of the 3 month process, has it worked out for anyone yet? Scared I will spend all this money in copays and then will get denied...

I was approved the first time they submitted. Bmi 40, I think as long as they include everything required it takes about a week to week and a half to hear back fro Aetna. I had an 7 year history of weight loss attempts (120 lb loss in 2008 and then slow gain of 50 of it over the years) . Hope you get good news

I have Aetna TRS. After my office submitted paper work, it took about 3 days for them to approve. I started calling immediately. Had I not, I would have received a letter about two and a half weeks later. I am glad I did not sit around and wait.

According to the details of my plan (I had a choice of a three or six month deal) I had to do a Lo cal diet, exercise regimen, nutritionist visits, etc. It is ultimately the nutritionist who submits the most important details...the exercise regimen, the diet, behavior modification. Make sure your nutritionist is one who works with a bariatric doctor. The doctors office should know exactly what is needed. I kept questioning mine but man, they knew exactly what they were doing!!!!

I was very frustrated with Aetna at first because of all the hoops. It overwhelmed me. They really came through for me.

This is basically where I'm at. I'm in the middle of my second month, I am seeing the trainer and the nutritionist that were recommended by my office, and I have to see my primary care doc. If you don't mind me asking, how much did you end up paying?

I have a bariatric surgery co pay of $5000 but my doc only made me pay $2000 of that. My doc required EGD $1100, sleep study, $1000, cardiac clearance about $150, hospital about $3000 so right at $7000. I got gap insurance this year, first year offered, and I don't think its thru Aetna. I will have paid $600 for the year but I will get back $2500 cuz I stayed a night. So my personal total will be about $5500.

Btw paid the first two grand with my health savings card and paying hospital off monthly. Got the rest from savings.

Yes Aetna approved surgery after I followed their instructions for what needed to be done, the cost of out of pocket expenses depends on you using an in network or out of network provider, your own deductible and coinsurance and how much you have paid for the year out of pocket already. It is very important you are proactive to understand your insurance and out of pocket expenses and call the insurance if something is not clear.

Anyone else have an Aetna ***? I'm in the middle of the 3 month process, has it worked out for anyone yet? Scared I will spend all this money in copays and then will get denied...

I had Aetna and called them at the end of December of 2014, they gave me the number of a few dr's that preform surgery. Called and set up a seminar with a dr after I did a little research. Seminar was on Jan 8,2015, went to 5 months worth of appts. Dr summited paper work a few days after my sixth appointment around the end of May. I was going on Vacation and they said I would hear back when I got home. I actually got the call while I was still on vacation scheduled my pre-op appt and testing while on phone and surgery was 1 1/2 weeks later. They got back to Doctor within two days with approval and I had nothing expect a BMI over 40.

Follow all directions and make copies of all paperwork so you know the dr office has summited everything to insurance. Ask them to go over paperwork with you at your 4 monthly appointment to make sure you have all your ducks in a row!!! It helps when they have it all early! Good luck!!

My insurance carrier is Aetna. Luckily the surgeons office that I went through is very savvy about putting together the packet that Aetna demands. At my first visit, I was given a binder that includes in part, all the tests and protocol that would have to be followed before the office would submit it for approval. I took my time between the first appointment and making all the other appointments to make sure all the results were turned over to the doctor's office. (First appt was in May for consult, NUT started in May, all other misc appointments were then made, and surgery was December so I could do it while on Christmas break from school.)

As for out of pocket expenses, that varies depending on your health plan and deductibles and co-pays.