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 called today for the RD that is on Aetna's list for my plan and they let me know its likely Aetna won't cover the dietician visits required for bariatric surgery and that it will be about $100 for a 1 hour visit so that means at least $200 out of pocket for that for me for 2 more visits plus the one I did this month with the hospital's dietician this week.

Just keep on jumping through those hoops!

Congrats on your approval. Maybe I'm right behind you.

I found out by surgeons office gave them a surgery date of 12/30/07, so maybe that will speed them up.

Speical K, you may want to check on that. I was told they wouldn't cover either, but they did cover two visits. I had to pay a small fee, but it wasnt' over $40.

Congratulations on approval!!!!! I have a question on the protocol. I have 4 more weeks of my supervised diet. AIGB will be submitting my paperwork at that time. If and when I get approval, do I then call Dr. Marsden's office myself to set the appt., or does AIGB do that?

Lonestar - suppossedly AIGB sends over the insurance approval to Dr Marsdens office, and then they'll call you. However, it didnt go that way with me. I got a "we need more info" letter from Aetna, so I called AIGB to make sure they had the stuff (they did, had already sent it) but they had me check with their insurance submitter, who said "oh, you were approved last week, no one called you?". So I had to call Dr Marsdens office myself. Now that was over the Thanksgiving holiday, so I wrote that off to busy with the holiday. My point - don't wait for them to call you, call and check on it yourself just in case so you can keep things moving!

I had my appt with the Doc on 12/6, and they scheduled surgery for 12/19. On 12/10 Jodie called me to say "can you do it on the 17th?". Of course I could! Make sure you take your approval letter with you to Dr Marsden's, as the one they had for me didnt have the approved surgery center on it, so they didnt know where Aetna required mine to be done at - so they had to take a copy of it. It was the Lewisville/Baylor surgery (nice place, great people, cept for the little front desk check in gal, she was rather humorless at 7am).

FYI - if you want to go to his Hurst office for appts, they told me he's there on Thursdays, and in his other office (can't recall where all of a sudden) on Tuesdays for office visits.

Best of luck on a swift approval!

Tina

I am at the starting line... I have been thinking about gastric bypass or lap band for years and am finally ready to get it but I have to jump through the Aetna hoops. From what I gather, I need:

1. 5 year history of ??? BMI (My weight has fluctuated within 40 pounds for the past 5 years - all over a 35 BMI).

2. Comorbidities??? I have acid reflux. I was put on Metformin by one doctor to see if it would help my "insulin sensitivity" but have not been dx'd with high blood pressure. I know I do not have sleep apnea but will I still have to get the test?

3. 6 month supervised diet. Can anyone tell me about this? Is a diet that Aetna recommends or my PCP? My PCP wanted to send me to a diet doctor that used the Atkins approach but it was going to be about $3000 - $5000 out of pocket. I know my PCP will not rx me diet pills as she is anti-Ambien, etc.

I have so many questions and want to prepare myself to do battle. Any prayers, suggestions, personal experience, etc would be greatly appreciated. Congrats to those who have been approved and who have had the surgery. :eek:

tmarie07 - Thanks for the info. I will do as you suggest, and call and check on everything and make sure it is moving along. I think Aetna will require me to use Baylor in Lewisville as well. Used it before for my daughter, and was basically pretty happy with it, except for this one nurse. Anyway, thanks for the pointers. And congrats on being banded, hope to join you soon!

I also went to AIGB and my Dr was DR.Marsden I called everyday I found out I was approved before AIGB found out I called and told them they only call onece a week and they had called the day before I got approved so If I had to wait on them it would have been another week so when I found out I was approved I called Dr. Marsden office and setup my pre opt appointment because Dr. Marsen will do a 10-14 day pre opt diet but want to the surgery til u have the letter in hand ....by the way he is great me and my coworker had the surgery her Dr. was Dr. Carter her incison is huge you cannot even see mines. :whoo:

GOOD LUCK EVERYONE

Dr. Marsden is in Argyle on Tuesday and he just open a office in Austin

AIGB called to let me know I was approved, after I finished talking with them, they transferred me to Dr. Marsden's office for the consultation.

I am insured with Aetna on a POSII plan. Ultimately it will come down to whether or not your employer's group plan covers you -- not Aetna in general.

The surgeon's office submitted my paper work the last week of May. Between then and the last week of July I was denied FOUR times and was on my last and final appeal.

(The next step would be to go to my husband's employer and beg them to rewrite their group policy to allow for WLS! -- Can anyone one say "career suicide"?)

With the last submission my ANGEL at the surgeon's office requested that someone who specializes in bariatric surgery study my case file.

Instead of the customary 15 to 30 day wait, they came back with an answer in about 3 days.

DO IT and DO IT NOW!!

Hallelujah!!!

Best wishes to all of you who are in the trenches fighting for coverage. I'm four months out and we're getting the bills and seeing just want we might've had to pay if I hadn't MIRACULOUSLY gotten approved.......it's terrifying!!!

I still havent heard anything...this sucks!!!

I am at the starting line... I have been thinking about gastric bypass or lap band for years and am finally ready to get it but I have to jump through the Aetna hoops. From what I gather, I need:

1. 5 year history of ??? BMI (My weight has fluctuated within 40 pounds for the past 5 years - all over a 35 BMI).

2. Comorbidities??? I have acid reflux. I was put on Metformin by one doctor to see if it would help my "insulin sensitivity" but have not been dx'd with high blood pressure. I know I do not have sleep apnea but will I still have to get the test?

3. 6 month supervised diet. Can anyone tell me about this? Is a diet that Aetna recommends or my PCP? My PCP wanted to send me to a diet doctor that used the Atkins approach but it was going to be about $3000 - $5000 out of pocket. I know my PCP will not rx me diet pills as she is anti-Ambien, etc.

I have so many questions and want to prepare myself to do battle. Any prayers, suggestions, personal experience, etc would be greatly appreciated. Congrats to those who have been approved and who have had the surgery.

If you haven't read it over yet. go to the Aetna Navigator web site where you can look up Clinical Policy Bulletin's and search for Bulletin #0157 Obesity Surgery and it details all the requirements for weight loss surgery. You need to give that to your surgeon or bariatric program coordinator you are working with and they'll let you know what medical and psych clearances and things you have to do.

Good luck.

I am at the starting line... I have been thinking about gastric bypass or lap band for years and am finally ready to get it but I have to jump through the Aetna hoops. From what I gather, I need:

1. 5 year history of ??? BMI (My weight has fluctuated within 40 pounds for the past 5 years - all over a 35 BMI).

2. Comorbidities??? I have acid reflux. I was put on Metformin by one doctor to see if it would help my "insulin sensitivity" but have not been dx'd with high blood pressure. I know I do not have sleep apnea but will I still have to get the test?

3. 6 month supervised diet. Can anyone tell me about this? Is a diet that Aetna recommends or my PCP? My PCP wanted to send me to a diet doctor that used the Atkins approach but it was going to be about $3000 - $5000 out of pocket. I know my PCP will not rx me diet pills as she is anti-Ambien, etc.

I have so many questions and want to prepare myself to do battle. Any prayers, suggestions, personal experience, etc would be greatly appreciated. Congrats to those who have been approved and who have had the surgery.

Search the Aetna Navigator web site and look for Clinical Policy Bulletin #0157 on Obesity Surgery and share that with your weight loss surgeon's office to be sure you jump through the right sequence of hoops or clearances and nutrition stuff they require. I'm working through this myself now.

Buffetchick1 - I am an Aetna subscriber also. And still on my journey of satisfying Aetna. I finish on Jan. 21st and then we will see if I can get approval. There are so many differences in each person's coverage, that you need to ask specically what applies to the coverage that you have. For instance, some Aetna people have a six month supervised diet program and others have a 3 month. I have a 3 month required supervised diet program. I keep a food diary, show up once a month and everything is documented in detail about how I am doing. I had a psyc eval. and two nutritionist appts. to do. One at the beginning and one right near the end of the supervised diet. A 5 year weight history is pretty much standard for everyone. It means physician documented weight. Aetna did not require a sleep study, but I had one done anyway. I have diabetes, sleep apnea, high cholesterol, high blood pressure and a starting BMI of 41.6. I have lost a little weight on my supervised diet and my BMI is now 39. The time has really gone pretty fast for me because of the holidays. I just hope I can get approval and get my surgery sometime in Feb. Just can't be sure. It seems very unpredictable. Good luck to you on your journey.

Thanks for the encouraging words. I meet with my surgeon's insurance specialist on 1/9 & will find out exactly what my policy covers (or doesn't). Good luck with your journey as well.