Clinical Policy Bulletin:

Obesity Surgery

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I am almost on the same timeline as you. My claim was submitted Tuesday. I hope to hear good news this week.

Well I won't be hearing anything unless my suregons office submits it. As far as I know they still haven't done it. But good luck to you! I hope you get approved the first time around.

The insurance approval process is such a game. It seems so twisted as compared to approval for other procedures and surgeries. I have read through this document numerous times and almost always say "I meet almost all of these". The issue is that there are little clauses everywhere that can be interpreted many ways. In other words, you can end up not qualifying because of one of these. I do believe that insurance companies use this as a delay tactic to thin out the herd. In other words, you can get the surgery if you persist. That seems counter to Aetna's claim to be a health care partner and managing the health of the whole individual. It's good marketing material but not good for the bottom line. So, keep up the fight. I intend to.

Tom from Ohio