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.

Laura,

Congratulations on being approved. I have a question for you. Did you do the six month or three month diet? Also did you have an co-morbities?

I just completed a 3 month supervised diet and exercise program. My claim was submitted to Aetna 2 days ago. What was the response time for others covered by Aetna? I understand that they assign a nurse to do the review. My surgeon's office says it is typically 7-10 days. I have high hopes since i have 4 comorbidities, 12 year history of weight from my PCP and a BMI of 41.

I just had a quick question. I was just wondering as to how much everyone paid out of pocket for everything. Thanks!

Hi Drew05,

I spent $1400 on the diet. $75.00 on the PCP and $20.00 on the psych eval and $100.00 on the exercise phys and dietecian. Oh $25.00 on the suregon. That is what I have spend thus far. I hope that helps.

Ah ok cool. Thanks for the rough estimation. The $1400 on the diet, was that copays or just the food?

Laura,

Congratulations on being approved. I have a question for you. Did you do the six month or three month diet? Also did you have an co-morbities?

Thanks so much! I did the three month diet and I have sleep apnea. I met the baseline for the Aetna requirements. I have a BMI of 36 and an Apnea/Hypopnea Index (AHI) of 15.6 which qualified for the treatment of Obstructive Sleep Apnea under the Aetna Clinical Bulletin. Aetna denied my claim at first because they said that my sleep study doctor didn't sign my sleep study results (however it was digitally signed) and that they needed a definition of hypopnea from the sleep center. I went back to the doctor who reviewed my sleep study and had him sign the report and got the sleep center to provide the definition. I provided all of my information to my bariatric coordinator who reviewed it. She was then able to set up a peer to peer review between my surgeon and the reviewing doctor from Aetna. After the phone conversation, my bariatric coordinator submitted all of the information that was discussed to the Aetna doctor. Once he reviewed it, he overturned my denial and issued my approval! That was great because I wasn't required to submit a formal appeal. I LOVE my surgeon and his staff!

I must say that I thought Aetna was great to work with all in all. If you have a legitimate claim and have jumped through all of the hoops, you will be approved! :tt1:

I just completed a 3 month supervised diet and exercise program. My claim was submitted to Aetna 2 days ago. What was the response time for others covered by Aetna? I understand that they assign a nurse to do the review. My surgeon's office says it is typically 7-10 days. I have high hopes since i have 4 comorbidities, 12 year history of weight from my PCP and a BMI of 41.

I got my denial in 3 days. After my doctor completed a peer to peer review on my behalf, the approval was received in one day! Hang in there but don't be afraid to call Aetna to check on it either if you're curious. Good luck to you! You will be successful! :tt1:

I just had a quick question. I was just wondering as to how much everyone paid out of pocket for everything. Thanks!

Hi Drew!

I paid a $1000.00 program fee to my surgeon's office. That included the diet, the three monthly visits, and the nutritionist. I paid $300.00 to the psychologist for my psychological evaluation. My surgery is scheduled for 5/21 and will cost $200 for my copay. I hope it will be well worth it!

Have a great day!

Hi Everyone!

I have been approved with Aetna Open Access POS II. It took no time at all. My insurance coordinator told me that I had all of my ducks in a row. I did get doctors records from 2005-2007. I have been going to a endocronologist and we talked about diet and exercise every 3 months in 2007. I used all of there records and I sent in 3 months of diet info from my PCP this year along with nutritionst reports too. I also took someone's adivce and highlighted my name, weight, dates and where it talks about diet and exercise on my doctor's notes. I called Aetna last Thursday and they said that my paperwork was in the approval stage and I heard today at 1PM that I was approved:thumbup:. I should be banded in June.

PM me if you need any help with Aetna.

I paid 250$ for the psych eval, 25$ copays for my 4 apt s for the 3 month regime, and then 989$ is whats due for the surgery after Aetna paid. I checked online at Aetna Navigator and they paid almost 19,000$!

<3 Aetna!

So total for my surgery 1350$ about.

I was wondering if you got approved yet. As for me I just got my second denial. Im so not giving up. Im going to file for the arbitration and see what someone besides aetna thinks.

JDUBO414 - OMG!!! Congratulations!!!!!!!!!!!! I just came on yesterday to look and see if it had happened yet. I am so happy for you guys. You are doing so well since your surgery, I am sure your husband is so anxious to get his journey started too. Good luck.

Yeah!!!!!!!!!!!!!!

thanks lonestar, yeah we're pretty excited. he has lost over 30 lbs without it, just following my methods, so now he's gonna wait till June to have it.

Drew,

I am pre-op. My insurance is coving all the tests at 80%. My surgeon has a $1600 admin fee that Aetna wil lnot pay. My flexible spending account will cover most of it. I did my diet through my PCP and only paid the $20 office visit copay 4 times. I think I have maybe $400 out of pocket so far. My surgeon requires 4 weeks of Optifast. That will cost me $116/week. I think I added everything up and with the surgery and all I will most likely have $5,000 out of pocket total.

Tom

Drew,

I am pre-op. My insurance is coving all the tests at 80%. My surgeon has a $1600 admin fee that Aetna wil lnot pay. My flexible spending account will cover most of it. I did my diet through my PCP and only paid the $20 office visit copay 4 times. I think I have maybe $400 out of pocket so far. My surgeon requires 4 weeks of Optifast. That will cost me $116/week. I think I added everything up and with the surgery and all I will most likely have $5,000 out of pocket total.

Tom

Ok cool. Thank you everyone for all of the input! I am so sure I'll get this all taken care of. I can't wait!

I was approved by Aetna today! Yeah! It took 8 days ftom when the surgeon's office submitted it. I have a pre-op information and scheduling appt. this Friday with my surgeon.