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 just started the 6 month weight loss with my doctor. I'll be done with that in July. I have documentation from my doctor stating I have a BMI 35+ for 5 years. I meet all the criteria that the insurance needs. The Bariatric Coordinator says they will deny me because I don't have a BMI of 40+ for the last 5 years. She said she'll submit all my paperwork to the insurance when I'm done with the supervised diet but she knows I'll be denied.

Your Bariatric Coordinator needs to get on her job then. Why is she even submitting it if she thinks you have no hope. Do you have any co-morbilities? Do you snore?

I have my 3rd apt out of 4 with the "3 month" physician on the 25th... and my 90 days is over end of next month. I did my sleep apnea overnigth testing over the weekend... and am getting my medical records together, although I do not have 5 years in a row, I have 12 years of being pretty grossly overweight. So we'll see- its going to come down to whoever reviews my file and if Im denied Ill appeal it. Hope everyone else keeps chuggin along as well!

Where you able to sleep in a foreign bed? My doctor says he believes I have sleep apnea and I have to have the same sleep test, but I have a hard time sleeping in a foreign place without my husband, including hotels. Do they give you something to help you sleep?

kimillionaire - I also have Aetna. I finish my 12 week supervised diet in 18 days. Lots of people have to do 6 months, so be very grateful for the 12 week requirement! The diet you choose is up to you and your doctor. Then you keep a food and exercise diary and check in to be weighed once a month. I also had to do a psyc eval., one visit to make sure I understood what I am getting into, and two appts. with a nutritionist (one in the beginning, and one next week). You also must provide 5 years of weight history. Records from a doctor's office, any office that documented your weight when you went in for the appt. You must also fall into their BMI requirements. I have tried to follow the criteria and complete everything they required. It remains to be seen if I will get approval. It seems very hard to predict what they will do. Paperwork to be submitted to them on Jan. 21st. Then the wait begins.

Good luck to you on your journey, and I wish success to you are getting your approval.

Lonestar, please let us know when you get approved. I'm curious to see how long it takes.

I have Aetna HMO and I live in New York. I had to do a 6 mos supervised diet and they strictly required that my doctor have notes each of those months that said that he told me to 1)diet 2) exercise and 3) get surgery. I also needed my own progress notes; 2 entries a month that said the date, weight and my own feelings about what I was going through. It sounds very complicated but it wasn't that bad. The problem that I had is that I didn't realize that the doc had to have those notes so he had to add an addendum after the fact with those notes on it. After the surgeons office finally sent it in, I got approved the following business day.

I just got approved by Aetna today.. It wasn't very hard. It took me calling everyday to be sure it was being worked on. Aetna got my claim on the 9th and I got approved today so although it felt like forever it really wasn't. I have Aetna Choice POS II.

Congrats on you approval:biggrin:

kimillionaire

I will let everyone know as soon as I know, for sure. I only have one more day after today on the supervised diet. I go Monday for my final visit and then they will submit to Aetna. I am excited and scared at the same time. I will be so sad if I get denied. But I am trying to think positive about approval. Will know soon and will let you know how it goes.

I have an appointment with my doc on Monday 1/21. Here in NV we have to go to an info meeting 2/12, then get scheduled with a bariatric coordinator after that. Do I need to get ahold of my GYN and have them get me the paperwork on my diabetes and weights? Is there a form they are to fill out? Is there a form I can use, or tell them to use? Thanks for your help.

I just got approved by Aetna today.. It wasn't very hard. It took me calling everyday to be sure it was being worked on. Aetna got my claim on the 9th and I got approved today so although it felt like forever it really wasn't. I have Aetna Choice POS II.

I have this same insurance I think. Congrats on your approval. I hope I can get trhough this without a nervous breakdown.

kimillionaire

I will let everyone know as soon as I know, for sure. I only have one more day after today on the supervised diet. I go Monday for my final visit and then they will submit to Aetna. I am excited and scared at the same time. I will be so sad if I get denied. But I am trying to think positive about approval. Will know soon and will let you know how it goes.

Lonestar,

I wish you all the luck in the world on getting approved. My only advise to you is to call EVERYDAY!!! you need to contact the pre-certification number. That take you right to it and they are more helpful than the regular customer service reps. Be sure your doc's office FAXES the documents. I actually had to call to verify it was faxed and not mailed. Once I knew it was faxed over I called daily to double check the status. They'll tell you if it is still pending review or pending approval. I got my approval on the 16th of this month. The office submitted the papers on the 7th (not the 4th as I was originally told,boy was I upset) so not including weekends I was approved in 8 days. Now once the insurance informs you or the approval (fingers crossed), call the dr's office ASAP. The office can confirm over the phone the approval with the insurance company.

Aetna sends approval letters to the dr and one to you. Unless you want to wait for the dr to get the letter, confirm the approval, and then call you to let you know (which could probably be ANOTHER 1-2 weeks) you should definitely call!!

GOOD LUCK!!. and PLEASE let us know when you get approved!

Okay, friends I think my surgeon's office bariatric coordinator is going to be making the first try at insurance submission for approval for lap band surgery. I'll recap here what I thought the packet had to have in it and we'll see if its enough.

1. PCP records from 5 years showing height, weight (thus BMI calc) and any progress notes about talking to me about weight loss.

2. Cardiology, sleep, and Psychology clearance letters.

3. Hospital nutritionist appointment documentation and 2nd nutritionist appt 1 month later. (may need to finish a 3rd one?)

4. BMI over 40 so that's not the issue.

Wish me luck! I'll let you know by posting how many days it takes from the time they confirm they have submitted until we have Aetna's decision.

Hubby lost job and insurance! Oh well. He got a new job the very next day, but won't be eligible for benefits until 90 days. Oddly enough it's Aetna so I'll be starting this process ALL OVER AGAIN! Yuck!

kim, so sorry to hear about your husband losing his job, glad he was able to get one quickly...where are/were you at in your process? I'm almost through, have 3 more weeks of exercise and food journal, will be submitting everything on Feb 15th. You sound very positive, that's great!

I'm starting completely over because the surgery center messed up on my first submission, messed up both of my appeals and now i'm going elsewhere to try again with the comprehensive presurgery preparatory diet and exercise program. So 6 months after starting the procedure, I'm starting over.Fun.

Could you please share with us what they messed up? My center just submitted for me and I am so nervous about this process being in someone elses' hands besides mine. Thanks.

:mad:Okay so here is the scoop.

Did the 6 month supervised diet, nutritionist, pysh eval, 5 yr hx of obesity 48% bmi. Got the approval in Sept 07. Had my surgery Nov 26th, 07. Paid my 20% co-insurance (around 1000.00). Now........I have received a bill from the anesth. for 20% of his bill? And also now Aetna is putting all the other bills (surgeons) under clinical review? So now 6000.00 is pending. What in the hell is this mean to me????)*%#W!#

I have an approval letter from aetna for the surgery. I tell you what, I called aetna today and of course all i could get from them was, I am sorry but this is under review, no I cant tell you if you will owe money.......holy crap can they really go back on their approval letter?

I am so flippin mad with this insurance scam crap. Why cant this country go to socialized medicine like so many other well-adapated countries.....grrrrrr

:frown:

Has this happened to anyone else out there....feedback would be greatly appreciated.