I just called Aetna to check on my clain for surgery. They said they called my Dr.'s office yesterday asking for my six month supervised diet. I never did a six month. I only did the three month multi-discplinary surgery one! I paid $1200.00 just to do it. I hate them. I don't know how everyone else has gotten away with only doing three months and they get approved. I don't think this is fair. We all have the same Insurance why do they approve some and not others? Can someone please tell me how they got around the six months? I had my Dr. put down a list of diet's that I did in the past. I never went to my Dr. before to have them supervise my weight loss. I never thought of it. Sorry for venting but I am mad!:cool2::cursing::thumbdown::cursing::sad_smile::cursing::cursing::cursing:

I just called Aetna to check on my clain for surgery. They said they called my Dr.'s office yesterday asking for my six month supervised diet. I never did a six month. I only did the three month multi-discplinary surgery one! I paid $1200.00 just to do it. I hate them. I don't know how everyone else has gotten away with only doing three months and they get approved. I don't think this is fair. We all have the same Insurance why do they approve some and not others? Can someone please tell me how they got around the six months? I had my Dr. put down a list of diet's that I did in the past. I never went to my Dr. before to have them supervise my weight loss. I never thought of it. Sorry for venting but I am mad!:cool2::cursing::thumbdown::cursing::sad_smile::cursing::cursing::cursing:

I am sorry they are being a pain . is that the ONLY reason they denied you ? as frustrating at is it . Look at it this way . You can maybe do 3 more months or evne if you HAVE TO do 6 months then you will have your surgery !

maybe it was a mistake ? have you called the docs office ?

Good luck

Mindy

Been there! I have Aetna too. When I talked to the Surgeon's office they said that my plan had a 3 month multi-discipline deal too, but what they didn't tell me until after I got turned down is that the insurance company usually doesn't go with the 3 month, because they don't think that you've really tried or shown seriousness of trying to particpate. Luckily I was able to resume my monthly dtr visits to make it 6 mos, total. The told me that if there was a break in the 6 mos period then I would have to start all over again. F that!!!:cool2: So I kept going to 6 mos. and then resubmitted everything with an appeal letter. I got it. I'm not sure if it was the appeal letter, because I have to "toot" my own horn and say that I put together a smokin letter. Or...they leaned toward that I've been over 40 BMI for 3 years as opposed to the 2 3 months ago. (much of this is because my last monthly check up was January of this year). So I lost a below 40 BMI with no issues to a year of a 40+ BMI. Ya know added a year and dropped a year for a 5 year history. Whatever! Just keep doind what your doing. Sorry you had to shell out so much money. If it goes through, just consider it an investment into your future.

I was just suprised that my insurance even covered it. Most do not. Mine is 90 % after my deductible of $250. 9 more weeks to go...... Hope this helps alittle. Susan----Have a good holiday weekend!

Aetna didn't deny me as of yet. They said where is my six month diet? I did three months on the pre-surgical and I am still going. Just for this reason that they may not let me do three months. Come to find out the nurse which I told last week to send in my diet didn't. Aetna called her again yesterday and said fax it in which I don't know if she did! I am so fustrated. I just want the surgery.

Hi Susan,

Thank you for your reply. I haven't quit going to my diet place because I was worried that they might not approve me on the three month. But I can show five+ years of morbid obesity. But my suregons said the less info the better. She didn't send over my diet which is why I think I am having so many problems. Do I call the nurse back and ask her did you fax the diet over or wait? She told me not to call Aetna but I coulnd't help myself I had to find out what was going on.

Oh shesh, AETNA, I have seriously had run-ins with this insurance company for years. They even denied my husbands claim when he had a heart attack while away on vacation! Now how can they deny that?! Of course we were "out of network" we were "out of country!" :cursing:

What I did realize with Aetna and that experience was that if I called every day, got names of everyone I spoke with and stayed on them, they finally approved our hospital bills. It did take some tenacity though!

I'm haven't submitted anything to Aetna yet for my Lap-Band, but I'm sure it will be a huuuuge run around.

Hang on and remember why your going through this whole thing. It's a gift of life!

Hi!

I have Aetna and there are many plans within Aetna. My plan allows a 3-month supervised diet within the last 2 years and then a 3-month followup diet. I had 4 months of doctor visits last year and then did 4 months this year. They denied me at first but my surgeon's office went over my history with the reviewing nurse. They approved me and I'm scheduled for surgery June 27th! I'm excited but plan to see my PCP next week and then in June before the surgery so I have 6 months, just in case. Hang in there!

This is why I decided to go self pay! When I called Aetna to check my coverage they said I only needed to do the 3 month diet... but I just had this feeling that it wouldn't stop there and they would say 6 at the last minute!! Don't get me wrong... I don't have a money tree in the back yard... but I found a way to go ahead and pay for it... just couldn't bare the thought of having to wait 6+ months to make this happen! I'm so sorry they have given you the run around!

This is meant as no offense to anyone ... If I had to do 6 months of a diet to get my surgery paid for I gladly would have. I had to borrow money from my parents and take out a $8K loan to get my surgery paid for self pay .

I would have waited 6 months hell even a yr to get the surgery paid for.

My point ,, I KNOW IT seems like forever, I waited for a yr after I decided to have surgery until i could afford it . But look at it this way.. its better than having to shell out $12K Plus to do self pay ??

Good luck yall I hope it goes well .

Mindy

aetna sucks. i HAD them and in the 11th hour the dq'd me based on the LB being 'cosmetic'. bs!

i then switched to blue shield ppo. and it was all good.

This is meant as no offense to anyone ... If I had to do 6 months of a diet to get my surgery paid for I gladly would have. I had to borrow money from my parents and take out a $8K loan to get my surgery paid for self pay .

I would have waited 6 months hell even a yr to get the surgery paid for.

My point ,, I KNOW IT seems like forever, I waited for a yr after I decided to have surgery until i could afford it . But look at it this way.. its better than having to shell out $12K Plus to do self pay ??

Good luck yall I hope it goes well .

Mindy

No offense taken. I did what was right for me... I did not care for the doctor my insurance would pay for. His office staff was rude on each occasion and I knew then that he would not be my doctor! The only alternative was to self pay. I know that everyone has different financial situations and if things had been different for me... then yes I would have had to suck it up and go with insurance. Luckily I had options and I'm comfortable with my decision and in the end that's all that matters.

Paige, I agree with your decision. In the end you have got to trust in your doctor and feel confident and comfortable with the office staff. When I had gyn issues and needed surgery, I shopped around to find the right doctor that would not only listen to me but truly understand what I was going through. I'm a big believer in having a working relationship with your healthcare team! :rolleyes2:

Deb

Hmmm. Id quote their website which says 3 month OR 6 month. 4 people I know who were approved through Aetna did the 3 month including myself, and had no problems. And I didnt even try..... in fact, I GAINED weight during that period, and was approved.:confused2:

In all reality i think this issue falls on the doctor mostly !! IMHO

The docs and the docs offices deal with insurances enough and on a daily basis they KNOW what is required or is needed for the best chance of a patient getting approved. So if 6 months gets you a better shot then they should not even submit the paper work until 6 months.

Does insurance suck . YES it does ! I cant even get it now cause im banded ( self employed) Insurances do need to be consistant I have never understood why one person gets it and another does not with the same situation ?

I would just submit the 3 month multi-disciplinary records and a copy of their policy that shows they accept that in place of the 6 month doctor supervised plan. Sometimes the reps on the phone don't always give out accurate info and you have to push them to follow their own policies and procedures.

I agree MacMcdame, send in their specific requests. As a matter of fact you can print out the clinical policy easily by going to their homepage website at Aetna.com

Thats what I did, I simply cut & pasted it into a Word doc. and I'm bringing it to my PCP on Tuesday. With the specifics there shouldnt be any question what is expected. :biggrin:

It's not playing hardball its just understanding the rules; their rules!

Deb