I have Aetna POS insurance and it covers 90% for the lap-band surgery. Well, someone mentioned to me that though the surgery is covered, you have to go through 6 months of recorded weight loss attempts with your doctor. Well, I know that I have some record with my doctor and I want to get a jump start on exactly what I will need. No one will tell me. In 2005 I had my twins, so I don't have a record for 2004 and 2005. My first consult isn't until June 25th, but if I need to start seeing my doctor before that I want to get going on it. Please, please, please give me feedback. I'd like to get a jump if I can. I am 36 years old, 243 pounds, 5 feet 7. I also previously went to a diet doctor in late 2005 for diet pills, but it wasn't with my PCP. I am just confused on what to do.

Wow that is terrible. Did you see what was submitted into Aetna? Maybe you Dr. missed sending in part of the six month diet. Aenta is into playing games right now. So review what was sent in. Make sure all six months were sent in and documented.

I have Aetna as well. I have a BMI over 40 and two co morbidities. I did the 6 month program with regular doctor and I have been denied. I am meeting with my doctor tomorrow to find out what is going to on.

Anyone have experience with the second appeal process?

thanks

Dennis

I would find a contact person at Aetna to speak to. Your employer should have a number to the person who would handle their accounts. I had to contact them that way because Aetna is my secondary insurance and they would not approve me as a primary payor. But I wanted to make sure I met every single one of their requirements, so I had my husband talk to the human resource person and they gave me a contact person, and believe me its best to have an inside person to speak directly too, she has been most helpful... and I found out she had gastric bypass 3 years ago, so she was very sympathetic to my case!

Good Luck!

Tess

Hello Everyone,

Here is the latest and greatest update with the Aetna drama. I got mad at them yesterday for saying they needed to see other diets I have been on. Well my Dr. sent them a list in her letter to them. I sent them a fax telling them all the diets I have been on and how much weight I lost and so forth and so on. With this fax I also sent them their own clinical policy and told them that I did their three month multi-discplinary diet as described in their clinical policy. I also sent them the New Direction diet that I am on and underlined everything showing them I met with a ditecian, exercise psychologist, behaivor modification specalist, and Dr. weekly along with attending nutrition classes. That is exactly what their policy states and that is what I did. I guess you just have to remind them of their own policy. I am still on the diet though until Aenta approves me. Just in case they come back and say you have to do six months! But I will be done with six months on July 8th so hahahaha to them. Sorry for venting but I am really sick of the games. I also found out from the Psychologist that is at my diet place that people who fight and show Aetna they really want this get approved. He said by me faxing information to them and showing them their policy show's them I am serious. So if you are having issues with them like I am don't give up. Remind them of their own policy and keep calling. Twice a day if you have to. Don't let them brush you off if you really need the surgery! Good Luck to everyone!