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.

JDUB0414,

If that's the only thing they are using as a method of denial, I would appeal again.

My surgery date is April 8th. Initially they denied me. I did the 3-month multi-discretional diet with my PCP and a dietician and resubmitted the paperwork and was approved.

Thanks Lonestar...Next Tuesday is my big day. I'm excited.

Edited April 1, 200818 yr by NeNe967
replied to the wrong person.

Congrats NeNe! Tell them you want your sugery April 2nd like me!!!

Hey I wasn't able to get April 2nd, but I will be praying for you today and tomorrow. However, I was able to get April 8th. Keep me in your prayers too.

Hey I wasn't able to get April 2nd, but I will be praying for you today and tomorrow. However, I was able to get April 8th. Keep me in your prayers too.

Im starting to get freaked out :crying: Thanks for your prayers and support. I am dreading having to walk into the operating room and laying down on the table... and waiting to be put under!!! Im starting to have anxiety attacks at work now. I will DEF be praying for you its been a long time coming! PM me Ill give you my email we're close enough in surgery dates to keep in touch for support lol.

Haven't visited yet, but I will. Hang in there. How are you doing?

I'm doing good. I've been on mushies this week and have gained some weight back. tomorrow will be two weeks and I've worked out here and there. I will start a everyday routine tomorrow to see if that will help.

I called again today and said I have to resubmit without the appeal letter as a brand new and he should be approved then. So our nurse at the weight loss center said she will send it out again today. Fingers crossed.:thumbup:

I am also awaiting approval from Aetna. I'm so nervous. I have a BMI of 40 with Sleep Apnea. Hopefully I will get approved. They have had my paperwork for 1 week now. I soooooo excited. I can't wait! I will absolutely loss it if they deny me.

I am also awaiting approval from Aetna. I'm so nervous. I have a BMI of 40 with Sleep Apnea. Hopefully I will get approved. They have had my paperwork for 1 week now. I soooooo excited. I can't wait! I will absolutely loss it if they deny me.

If WLS is covered under your plan, and your BMI is 40 with sleep apnea, you should def be covered! Ill keep my fingers crossed dont worry they had my file for 17 days before I was approved.

temperence1972 - You qualify, you should be approved. Sometimes it takes time for them to get the approval done. Don't be discouraged, the length of time doesn't mean bad news. They approved me on the 30th day! It was hard to wait, but it came through in the end.

Hey quick question...I have the same insurance and they told me they cover 10k lifetime benefit for the surgery...how do i estimate what the difference will be that i'll have to pay out of pocket? what did you end up paying?

Has anyone gotten approved with no Co-morbities but just a high BMI? That is my case my BMI was almost 50 but now down to 43. According to Aetnas rules if it is over 40 you do need anything else but my Dr. seems to think they are going to give me a hard time. Hower I do have a pinched nerve in my leg due to my weight and plantar facitias as well along with heel spurs but they don't count those.

Has anyone gotten approved with no Co-morbities but just a high BMI? That is my case my BMI was almost 50 but now down to 43. According to Aetnas rules if it is over 40 you do need anything else but my Dr. seems to think they are going to give me a hard time. Hower I do have a pinched nerve in my leg due to my weight and plantar facitias as well along with heel spurs but they don't count those.

Flowerpurr,

I have Aenta and I have NO Co-moborities. My BMI is 42.7 and they APPROVED me. You just need to see all of the doctors that they require, have 5-year documented weight-history with your doctor, 3 or 6 month documented weightloss regime withy your PCP & a Nutritionist, and a referral to Weight Loss Doctor for your PCP. It also helps if your PCP is in your corner and documents in your file that he/she thinks this would be a great way for our to conquer your obesity. Also, the fact that you've lost 30 to date.

Call your insurance company at your convenience and ask if Weight Loss Surgery is covered under your plan. They also will probably refer you to a policy bulletin regarding the requirements based on your insurance.

Edited April 7, 200818 yr by NeNe967
Need to add more info and make corrections.

Flowerpurr,

I have Aenta and I have NO Co-moborities. My BMI is 42.7 and they APPROVED me. You just need to see all of the doctors that they require, have 5-year documented weight-history with your doctor, 3 or 6 month documented weightloss regime withy your PCP & a Nutritionist, and a referral to Weight Loss Doctor for your PCP. It also helps if your PCP is in your corner and documents in your file that he/she thinks this would be a great way for our to conquer your obesity. Also, the fact that you've lost 30 to date.

Call your insurance company at your convenience and ask if Weight Loss Surgery is covered under your plan. They also will probably refer you to a policy bulletin regarding the requirements based on your insurance.

NeNe,

I did look on the sheet but my PCP told me that it is hard with no co-moborities is all. I have been going to a special weight loss clinic. It does the pre-op diet. I see everyone from the excersise psychologist, behaivor modification specalist, detician, a Dr. there, and attend classes as well as check in with my Dr. once a month. Soooo I am just praying that I get approved this month. I go see the suregon on the 16th. But I also see him weekly as he is one of the Dr.'s that supervise the diet. Thank you for all your imput.

I've been watching and reading throughout my journey --- I have my last appointment with Dr. and Nutritionist on May 7th...and we have Aetna - which we have never had any problems with approvals for anything...hope my approval will not be the first one. I am right on the cusp of the BMI 35.7 so even though I'm on this Dr.'s supervised diet - I've been careful not to lose too much cuz it will put me out of the required BMI range for Aetna coverage. I have to admit - I'm sick of not being so concerned about losing any weight - I've got my head around this whole thing and really want to start this process - and even though I've not gained/lost much over the past 6 months I just feel so much more overweight now than ever! I'm ready. Keep your fingers crossed...!

I'm encouraged by the Aetna posts...most seem to be approved and moving along. Hope mine is as easy as most of these are.

Hi.... I have Aetna and just found out that it is no longer 5 years...it changed to just 2 years. I am waiting for insurance approval. My family physician was ready to provide the 5 years, but I contacted Aetna and asked about what all needed to be in my family physician's letter. That's when I found out it was on 2 years. I am concerned that I will be denied because I did not lose any weight during my 3 month prep regimen. I went to a Nutritionist twice and saw my family physician. Aetna told me to fax my doctor's office notes showing where we discussed it....hope that is sufficient!

Hello.... I also work for Verizon.... in Durham NC. I am waiting for Aetna to approve. My BMI is 43. I have sleep apnea and high blood pressure. I did the 3 month prep regimen, saw the nutritionist twice. I am concerned I will be denied because I did not lose any.