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.

My friend "thebonbon" just got approved by aetna ppo. Shes 5'2 205 lbs w sleep apnea and 2 years weigth history. Im 5'8 303 w sleep apnea and 2 years history so PLEASE Lord let me be approved

good luck! dogluv

Update on my Aetna journey. I usually only call on Fridays, but I had a really, really bad day today, so figured I would either try to get cheered up by an approval or take the hit for denial while I am already down. No luck either way. I don't know why they are taking so long with me. They told me that our company's health coverage is handled in a dept. that deals strictly with claims from our company. (It is a very large oil company) Wouldn't it be that way for all companies? Anyway, I told them I was concerned that all the documentation had made it where it needed to go since I got that letter after the first submittal. She said, and I quote "Oh we send that letter out as soon as we receive a request. It is standard operating procedure for it to go out." Okay, so that is settled. She said they received all the paperwork on Feb. 4th and that it went to medical review on Feb. 5th. She reminded me that it has only been 10 business days. I am really patient and calm and nice when I call, wish I could say the same about the people I have been talking to on the other end. But I keep calm and bite my lip. I have a BMI of 40, sleep apnea and diabetes, and actually 7 years of history. So are we talking 30-45 days business days, or just calendar days for them to make their decision. By the way, congratulations to everyone that has their approval in hand. I am jealous, of course, but truly happy for you all for I know all too well what this surgery means to all of you. Good luck. Still waiting---------------

Hang in there Lonestar! I am feeling your pain. I will not be able to submit my forms until April 7th. I know I will be impatient by noon that day. I'm watching your progress with my fingers crossed!!

Congratulations Special K. I have one question though did you just see your Dr. and a dietcation and had to do six months? Or did you do the multidiscplinary diet for six months. I am doing the three month but worried they will come back and say six. Can you let me know which one you did?

I had been seeing my PCP care doctor over the past year and discussing that I had been doing Weight Watchers faithfully, had been showing her my weigh in book, and evidently she had been documenting that. Plus I gave the surgeon's office the copy of my weight log book, and a nutritionist appt report from December and January saying that diet and exercise, etc. had been discussed. I ended up not being able to fit in a February nutritionist appt because now I've got approval. So... I'm not exactly certain what Aetna based the approval on for the diet requirement portion. They had 5 year of doctors progress notes showing I kept talking with my PCP about weight every visit, even about 3 years ago discussing RNY surgery with her, so maybe they just decided that there was a long enough history all around.

Whatever did the trick, I'm praising God!!

:tongue2:

Next tuesday submitting..... I am a ball of nerves for sure. I just want to go to sleep and wake up monday in time for my last supervised apt! It cant come fast enoough :tongue2:

Good luck everybody!!!

Also, I talked with Aetna for a while today and I remember somebody in the past mentioning them not covering the anestesiologist (sp) bill and that it was sent to them with fears they were stuck paying for the bill, but she said, "obviously you need to be put under to have this surgery so of course we pay for that too".. but she said the problem is that most lap band doctors don't share our insurance information with the anestesiologist doctor so they just send us the bill because they don't have a place to send it to. She said in that instance it's best to find out who will be putting you under and giving them your insurance information OR after you get the bill to call them and tell them to send the bill to Aetna.

I finally got a surgery date of 3/19/08!!!!

Congrats!!!!!!!!!!!!!!1

Wow, Its depressing to hear what alot of folks have had to do to get approved. I haven't experienced any of the paperwork issues/denials that some of you have. When I needed some form of documetation to continue the Nurse was ringing my phone off the hook. When I requested my 5 yr weight history from my PCP, the Bariatric Nurse was calling them twice a day until she recieved it. The Surgical Nurse kept everything in line and submitted the paperwork on the day of my last required weigh in. 5 weekdays later she called to tell me I was approved. 3 days after that I recieved the approval letter in the mail from Aetna.

I think most of the issues for denial are a reflection on the Staff doing the submittals. I wish everyone were able to get their approval 1st time as I did. Its hard enough to meet all the criteia without being denied due to missing paperwork.

My only problems with Aetna always were something the submitting Doctors office did wrong. Its a shame but the burden of proof is always on the patient.

For everyone discouraged by the insurance requirements and denials, It will get better!

Lache pas la patate!

(Don't give up!)

Well, after going through all the hoops Aetna requires, I found out last week that I was denied. They say I don't have the co-morbidities. But, I have sleep-apnea and high cholesterol, so I just don't understand. My BMI is 39. But, my policy says that your BMI only needs to be 35 if you have at least one co-morbitity.

My counselor at Lapband Solutions scheduled a peer-to-peer consultation with Aetna, but they never called, so she is rescheduling it for next week. After all this effort, I am so depressed I don't even want to get out of bed.

Has anyone ever had any experience with these peer-to-peer reviews? I wonder if they ever change their minds once they've made a decision.

Congrats to everyone that has gotten approved. I went to my Surgeon (2/12) visit, and they said I needed the 6 month diet. I told her that it had been changed to or, but she insisted that I do the 6 month. So my PCP put n the notes started in Jan so I still have 4 mos to go. I wonder if I call them again and let them know that the policy changed, I wounder if I could get by on the 3 month?

The Bariatric Coordinator at my surgeon's office insists I do the 6 month diet also. I was hoping to get by with the 3 month diet.:biggrin:

I am beaten down, exhausted with all this. Aetna has had my file in medical review for three weeks today. Still no word. I don't call anymore, I just wait.

^ I'll keep my fingers crossed for you. They submitted my precert today to Aetna but not sure if the review nurse got in touch with my wl center and requested my files. My best friend d got approved in one day through them. I can only pray for a swift approval like hers. Keep up the faith!!