I am currently going through the process to have lapband. Starting my 6 month supervised diet this week. Done my sleep apnea, stress test, pulminary function test, and a few more. Waiting for results. I have aetna NAP choice POS II. I want to make sure since i am spending all of this money for these test and supervised diets (around $ 800) that i have every thing that aetna needs to approve me for the surgery. The only thing that i worry about is the proof of being 40+ bmi for 5 years, even though i have. There were a few years in between that i didn't go to the doctor (not even the female doctor ) so i not for sure if i can come up with these records. So i would just like to here anyones experience with aetna good or bad. I really want this surgery so information would be very appreciated and helpful.

We are all so happy for you. I am glad you didn't have to wait long. I am also going through my husband's insurance with Aetna from the company he is retired from now. Hopefully, it will move fast as well. I also wonder if the retired medical is handled by a different area. I don't know, I am just glad we have it! Good luck with your surgery and your new life to come, healthier and happier!!!!

After checking the mail today, I received a letter from Aetna stating that they needed my five year history and documentation of my 3 month supervised diet. I am pretty confused. I know True Results had everything, they went over it with me last Monday before they sent it. So why did it not go to Aetna? And now, because it is Sat. I have to wait until Monday to get any answers. I think I will go throw up now, I am just sick.

After checking the mail today, I received a letter from Aetna stating that they needed my five year history and documentation of my 3 month supervised diet. I am pretty confused. I know True Results had everything, they went over it with me last Monday before they sent it. So why did it not go to Aetna? And now, because it is Sat. I have to wait until Monday to get any answers. I think I will go throw up now, I am just sick.

Lonestar - I wouldnt worry! Same thing happened to me when I knew True Results had sent it - got the same letter. So I called True Results (I dont check my mail every day, so the letter was probably a week old) and said - what the heck? They said, no we sent that, so Flora had me call the insurance gal who said - oh, you've already been approved, did they not call you? So apparently this letter is pretty standard. Plus my approval was done over Thanksgiving, so Dr Marsden's office hadn't really had much time to call me. Hopefully your scenario will be the same as mine! Don't stress about the letter, just check it out on Monday, and if the approval isn't in yet, I bet it will be in a week or so.

Tina

tmarie07

Thank you so much for your reply. It made me calm down alot. I will call Aetna at 8Am on Monday, as well as True Results and hopefully get it all straightened out. Thanks again, it meant alot to me to be able to see that someone else had the same thing happen.

I got in touch with Aetna this morning and was told that they did not have my stuff. I called True Results, and they couldn't have been nicer in the insurance dept.. They said they faxed 43 pages to Aetna last week. I called Aetna back (they were nice to me also), and they suggested I have True Results fax it over again. I did just that, and True Results was very cooperative and reacted quickly, faxing while I was on the phone with them. They called me back a short time ago to let me know that they received confirmation from Aetna of receiving the documentation. I will be calling Aetna this afternoon, just to hear with my own ears that they indeed have everything they need to make a decision. I now see why everyone says to call, and call and call. I will keep you posted on the progress.

I talked to a lady from Atena this morning. She called and wanted to talk to me about the surgery and while talking to her she said True Results was a pleaserue to work with they sent just what was needed. She also said that she worked for the IBM division and that IBM wanted people approved for this surgery if needed. Good luck and hope you hear real soon about your approveal.

Lonestar - glad to hear everyone seems to be getting all the docs. Since we both got that same letter, and I know True Results didnt refax anything of mine, I'd bet they pop that letter in the mail the minute they get a file in. Insurance companies, what can you do! Hang in there, and best of luck!

Tina

I got a call from Aetna around 3:00 letting me know that they do indeed have the fax and the documents now. I am thinking you are right on about the letter. It could be standard operating procedure as soon as they receive the request. I have just never had to deal with insurance before regarding precertification, except for dental. Now the wait begins. I wonder if they will call me or if I will get a letter letting me know approval or denial?

Hi:

I just need to vent. I received a call from my doctor's office today and they said that Aetna told them that this is not a covered procedure. I called Aetna and they said that "laproscopy" is a covered procedure and they will call the doctor's office and let them know. Now I am scared and am ready to cry. I can't believe that my insurance costs a lot, I am relatively healthy, and now they are going to deny me this chance to change my life.

The only good thing I am concentrating on is that I have a small hernia. If I can somehow get them to pay for the hospital and such as I expect to get the lapband and hernia repair done at the same time.

I could use some encouragement.......

Laproscopy is the way they do the band but they do a lot of other things using laproscopy. You need to ask Aetna if your plan covers the Lapband not laproscopy.

It sounds to me the Doctors office is not real interested or educated on dealing with Atena I would check with other Dr's in the area and see if they are willing to help you. Good Luck

Thanks for the info. The doctor's office is working with me. FYI laproscopy is the code that they bill it under. There is no medical code for lapband.

Unfortunately for me, this doctors group in the only one in my area that does this surgery. I would have to go out of state if they didn't do it. That brings a whole new set of problems for the insurance.

Circa:

Thank you so much! I didn't realize your post was a reproduction of the bulletin from Aetna. It makes me feel so much better!!!

Yes, I am just starting also. I went to my PCP a few days ago to find out what documentation they had, come to find out that the 6 month diet I was on will not count, because the nurse did not put in my weights (last year). So I guess I will have to start over. I talked with my coordinator and she said I may be able to do the 3 month thing with Aetna, cause it is an or. She said most people just do the 6 month cause they do not want so much in 3 months. I will do whatever it takes! My PCP just informed me that my choleserol is way high, but said nothing else! He is so not pro-active about this, I just might have to switch PCP's. Will that effect what I am trying to do?

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