Hello:

Wanted to comment on Aetna. Suprisingly, they have been SUPER responsive and approved me in less than a week. Obviously, one has to have the proper documentation or they will find a way to deny. However, once submitted, they have been agreeable and responsive. It literally only took them 3 days from receipt of all information.

PS-I called every day to check status. Perhaps this is part of the trick.

Best of luck to all

I have Aetna Choice POS II and had no problems getting approved for surgery. My doctors office handled everything and seemed to know exactly what to give them.

My question is - does Aetna pay for fills ? What if doctor is out of network (like mine) ?

I am working with the weight loss surgery center here in Nashville at Baptist. They do the 3 month "pre-op" program. I have not been asked to loose any weight during this time, just appointments, group meetings, all pretty superficial. I did get a psych eval. I have no co-morbidities, but I have had a BMI of >35 for 5 years that is documented. I guess I am thinking what I am doing seems to basic/easy to what I have read about other Aetna pre-ops having to do.

I have AETNA Choice II also, and was approved in 3 days. I just had to see my nutritionist once a month for 3 months and my primary care dr. once a month for 3 months. I didn't lose any weight during this time-they told me to just start changing my eating habits. Had all the necessary tests (sleep study, psychologist, etc). I have started the pre-op diet and have lost 8 lbs. in 7 days. My surgery date is April 14.

I have AETNA Choice II also, and was approved in 3 days. I just had to see my nutritionist once a month for 3 months and my primary care dr. once a month for 3 months. I didn't lose any weight during this time-they told me to just start changing my eating habits. Had all the necessary tests (sleep study, psychologist, etc). I have started the pre-op diet and have lost 8 lbs. in 7 days. My surgery date is April 14.

Do you have any co-morbities?

I only started thinking about fill cost recently. I had just assumed that they were covered. I saw people talking about fill costs on-line and I got worried. My doctor includes 90 days of fills for free as part of the surgury followup. A friend of mine told me that she pays her co-pay when she gets fills(she doesn't have Aetna). I am assuming that I will be doing the same. I wouldn't know what Aetna would do if your doctor is not on the plan. You should ask the office about the fees.

I waited to find a doctor on my plan.

Yeah, but be careful...I submitted everything to Aetna, was ready to rock and roll...until they denied me because I hadn't been at a BMI of 40+ for 2 years.

I dipped down a little bit back in January of 2006 (I was taking phentermine) so they denied me.

It so hard to grasp the concept of, "We see that you have struggled since at least 2000 when your medical records start, but since you were able to lose some weight at one point, too bad."

I am totally devastated.

If I had gone through my paperwork and taken out the one that showed me at a lower weight, I would have already had the surgery and be on my way to good health. But since I was honest, I am being punished.

I can't afford self-pay and would need a co-signer if I got a loan, which would be a struggle to pay every month but I would have to do it if I want the surgery.

I wrote an appeal letter yesterday and I am praying they have a change of heart. Otherwise, I have to find a way to get $17,000.

Please keep me in your thoughts if you would!

Jillypie,

My nutrtionalist said that if they deny you 2 times, appeal again and it goes to a Bariatric/Lap Band surgeon for a decision. and more than likely you will get approved. I hope this helps, and you are in my prayers!:crying:

Jillypie,

My nutrtionalist said that if they deny you 2 times, appeal again and it goes to a Bariatric/Lap Band surgeon for a decision. and more than likely you will get approved. I hope this helps, and you are in my prayers!:crying:

Really? But what could I say in my next appeal?

"Look, I know you've denied me twice, but come on, give a girl a break."

Thanks for the advice!

I would just reiterate what you have already said.....and quote al those things about the surgeries and stuff. If you go through the boards, or even the internet, type in "appeal letters for weight loss surgery" you can find a wealth of information......:crying: