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.

I'm brand new here (longtime lurker), but wanted to post my insurance experience because I know I was very nervous about that process and read this entire thread many times to make sure I was following everyone's advice. Thank you to everyone who has posted on here!

I have Aetna PPO and completed the 3-month supervised diet. My BMI is 41 with no co-morbidities.

My paperwork was submitted by my provider on a Tuesday. I called Aetna on Tuesday, but they said it would probably not show up in their records until the following day. I called on Wednesday and they confirmed they had the paperwork and that it had been sent to a nurse reviewer. I let one day pass (Thursday) and called on Friday, and they said it had been approved! I'm glad it went so fast! Anyway, wanted to post in case my info can be helpful in any way.

Hey Guys!,

My doctor submitted my paper work as of April 10th!! Please keep your fingers crossed for me. When y'all call for a status of your approval... who did you ask to speak to? I am anxious but I think I have everything I need to get approved (BMI of 45, Blood pressure medicine & Diabets). I am so ready for this!

I too was denied by Aetna. My problem was I fell below the bmi level within the two year period. My bmi was at 33.4 once within the 2 year period. Ive filed an appeal but I dont think it will do any good. Im getting no help from my surgeon. she doesnt do peer to peer. How did your peer to peer go did it help you. If so Im thinking of switching doctors.

I also was denied for this reason. My doctor did the peer-to-peer and they still said no. I'm not sure what was involved in that peer-to-peer phone call, but it was like they basically said, sorry, she wasn't at the right BMI for 2 years straight.

I submitted another appeal on my own, indicating 10 different errors I noticed in my doctor's records. I asked them how they could base a denial on records that were inaccurate.

I am praying they have a change of heart.

I am wondering if anyone has been denied because they were losing weight during the 6 month pre=op qualifiers???

For those of you who want to call on the status on your file w Aetna review- PM me I have the correct insider number to call!!!

For those of you who want to call on the status on your file w Aetna review- PM me I have the correct insider number to call!!!

I can't seem to find the "PM" button...

I have been calling 1-800-633-0636 and get through to the complaints and appeals dept with no problem.

Is there a special magic number where the answers will always be "YOU ARE APPROVED!"????

Is there a special magic number where the answers will always be "YOU ARE APPROVED!"????

Sure, it's 1-800-HEAVEN

hee hee

I have a question. Does anyone know if Aetna will accept the two year weight history for 07 and 08? Or will they want 06 and 07?

I had to turn in 06 and 07.

Hey guys,

I was banded on April 8th with Aetna Insurance. It has been a hard first week, but today is the best I have felt. I think it's going to be well worth it. I went for my 1-week appointment with my doctor and he said I am healing well. My appetite is still very little, but it is increasing. I lost 11 pounds since my surgery.:rolleyes2:

Way to go NeNe. Glad you are are the mend. I felt totally normal after that first week too. Keep up the good work!!

Have any of y'all had this problem......

While stalking the progress of my pre-approval. I had one operator (earlier this week) tell me they see me in the computer but I am not approved yet and just now another different operator say that I am NOT showing up and therefore my doctor has sent me to the wrong department. Has this ever happened to you? What did you about it....did you reappear magically or have to resubmit?

Have any of y'all had this problem......

While stalking the progress of my pre-approval. I had one operator (earlier this week) tell me they see me in the computer but I am not approved yet and just now another different operator say that I am NOT showing up and therefore my doctor has sent me to the wrong department. Has this ever happened to you? What did you about it....did you reappear magically or have to resubmit?:cry_smile:

miss meliss,

I would go back to my doctor's office and ask them to check on it. They usually have a relationship or person of contact with each insurance. They showed me APPROVED in the system before I got a letter and I alerted my doctor's office. The processor in the office called Aetna for an approval code for the surgery.

I hope this helps.

Ms. NeNe

Thanks for the advice NeNe. I have just finished typing up an email to the insurance cooridinator explaining my phone call. I will follow it up with a call on monday.

Ok so today I went to my PCP and she referred me to my surgeon... and let me tell you she was VERY negative telling me over and over how long this process could take... I kept on pushing that I didnt care and was willing to wait... I have to go to the seminar before the surgeon will even meet with me. I was lucky and there was a seminar this Thursday with a cancellation so they let me in! I hope the rest of this process goes so smoothly but something tells me im bound to hit bumps but i have faith that I will be banded soon! Can anyone tell me exactly what you have to do during your 3 month multidisciplinary diet thing so I have some sort of idea?? Also Ive been on a diet with the dietician although I continue to gain... could this be grounds for denial or should I start the diet with the dietician fresh??