Your Aetna experience?

[miss meliss 0]

Hey Polly,

I am in the process of being approved (postive thinking!). I started with my pcp and it was going to be 6 monthes of dieting and a lot of worrying that there might be a slip-up or missed documentation. After 2 monthes I went to a Lap Band Surgen with an experienced staff. By going to a dietian (at that office) I only have to do the 12 week monitored diet. Also I feel like I will less likely to be turned down because the office didn't do the proper documentation or forgot to do something. I hope this helps! I have Aetna POSII.... Meliss

[polly522 0]

Thanks Meliss, that is so encouraging. I felt so bummed that I have to start all over again. I also have Aetna POSII, through my husbands work (Costco). My weight just seems to keep going up and up. What kind of diet did your dietician but you on? Is it easy to follow? P

[miss meliss 0]

I am glad I could help! The diet is not really a weigth loss diet but training for the way to eat with the band. The 1st month she asked me to give up carbonated drinks and to add protien to my morning meal. She asked me to start taking smaller bites and chew, a lot. I had to keep an excercise log showing at least 3 times a week of 15 min. exercise. It could be as simple as walking or lifting light arm weights.

I went to my 2nd appointment yesterday. She asked that I stop drinking with my meals and told my why. Also, I need to start taking chewable vitiams. Continue with exercise.

I asked her about how much wieght should I try to lose... she said don't worry about it. This is a time to educated me on how to live with the band and prevent disconfort in the furture. She said she has never had a problem with Aetna expecting weight loss. However, if I didn't modifiy my behavior that she could not recommend me to Aetna. In fact she has had people gain weight because they where nervous and eat more right before the surgrey. She also has been going thru a list of foods that most people have problems eating.

This much easier than a pcp. The office is scheduling everything in the order it needs to be done. This is what they do and they deal with Aetna everyday.

[circa 0]

Well, unless i can come up with the funds to cobra my insurance, I'm done with Aetna and probably done with attempting to get the surgery. We'll see what happens (I was fired from my job because it was found out that I was going to be reporting sexual harassment - yes, I'm looking into a suit)

[Dandy Andi 0]

I have Aetna PPO in Texas. I was required to do a nutritional seminar, psych eval and 3 months of diet. I also had to provide 5 years of weight history and a letter of medical necessity from my dr.

I submitted paperwork on 12/16. Was approved on 12/24. Received my lapband last week on 2/4. Seems like once you get the thumbs up... it's off and running.

Good luck everyone! I'm still too new to rant about my band, but I'm sure I'll be able to soon.

[lonestar5212 0]

Thought I would share while I am on hold with Aetna. It is almost getting funny, all the bumps in the road I have. I have been on hold for about 10 minutes because the girl can't get her computer to move past the point where they see my info. Now she came back on to tell me that the computer finally moved and she can see that my case is still pending. But she says she can't see past that because our policy is handled by a "dedicated dept." that only handles claims from our company. So now I have hung up and called that number and am on hold again with them. I just want to make sure they aren't still missing any documentation that they said was missing last week. They received that stuff last Monday, so I am hoping that something else hasn't come up missing. Still holding-----

Okay, nurse just came on and said that "all documentation has been received and it has been referred to the medical review staff." So, I am still pending and they have all the docs. So, back to waiting. Hang in there everyone else who is waiting. I feel your pain.

[SpecialK 22]

Same boat here! Aetna telling my surgeon's office bariatric coordinator they still needed 5 year weight history and I knew it was something the surgeon's office should have because I had to pay $50 to get the 5 years of records pulled from storage. She called me back and said, nope, no weight history for 2002,2003,2004. Turned back and called the PCP office and they immediately began reading off the dates of my appointments and weights in those years. So now I'm waiting for the surgeon's office and PCP to synch up so the surgeon can submit it to Aetna. Sure is a long and winding road but I feel I'm getting close.

[lonestar5212 0]

Five year history just doesn't seem to get to Aetna for alot of folks on the first try!! Hang in there. Keep calling your PCP and surgeon's office to make sure they sync up, and then call Aetna and make sure they have received everything. Whew, this is exhausting!

[annesan 0]

Hi, new here but wanted to say that i have Aetna and was looking on the aetna website clinical bulletin today and they revised as of 2-8-09 the 5 years to two years ( at least that is what it says)/

I am just starting out and have my first consult next week. I hope to do the 3 month and get banded this summer when I am off( I am a teacher).

Anne

[Flowerpurr 0]

I just checked on their Clinical Policy and it is true. It does say 2 years instead of five! So they have to take everyones paperwork without five years! That is their policy. They need to follow it!

[SpecialK 22]

I'm going to go check for that Clinical Policy Bulletin and fax to my surgeon's office this afternoon! Thanks so much for the heads up. We've got bad weather in Ohio today and alot of kids are off school so no word from the doctors' office - they could have closed due to snow and ice...wouldn't you know when I'm waiting on the edge of my seat!!

[coolcrystal 1]

Wow, that's nice!! I submitted in January and had to have the 5 years, and it took me a week to get those past records because they wouldn't call me back and then they had to go to "storage" to get my old documents and finally faxed to my insurance company.. anyway, Aetna POS approved me in 8 days, so it can happen. I also work with Verizon, so there was a special department specifically for Verizon employees. Since my company is into health big time (we even have a fitness center at my job) I had a pretty strong feeling they would approve it.. Plus, I met all the requirements bigtime... So, don't give up trying folks!! Don't give up the fight!!

[SpecialK 22]

I posted the attachment for the difference on a thread under Insurance I titled:

Aetna Revises Policy downward from 5 years to 2 Years!

Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications.

[Flowerpurr 0]

I found another change under letter D Member must meet either Criterion 1 or Criterion 2! So that means we can do a three month diet! You have to see alot more people but you only have to do three months instead of six!

[JDUB0414 0]

This is really great news for my husband. We are resubmitting next week for him, along with a letter form him and our PCP. I wonder since they changed the policy if we have to appeal or just resubmit???