Aetna PPO, in NY

I have Aetna PPO and can go in or out of Network. I find that the best thing that you can do for yourself is to find out early on EXACTLY what your insurer has to say about weight loss surgery. Is it covered? Under what circumstances is it covered, and once you meet those circumstances, what is needed in order to be approved.

Before I seriously considered having the surgery, I found Aetna's policy on WLS. I knew I met the BMI + comobidities, so I knew I needed to fulfil their 6month verification requirement.

My dr. submitted my paperwork less than one week before surgery and Aetna requested only 2 additional things: notes from my dr. indicating my weight on a date she mentioned in her supporting documentation, and another from 2007 indicating my weight. once they received that, the approval was given the same day. So all in all, it took only 2 days -- one spent waiting for my dr. to pull out my chart and fax the extra documentaion over. If your doctor has a sample insusrance letter for you to use, I suggest that you take it and go over it with your doctor. Don't give the insurance companies more information than it asks for-- you could leave yourself open for more questions and end up having to dig up more information. which, is neve-wracking when all you want is your approval.