Hello all,

I have been completing my requirements for the lapband put forth by Aetna. During this process I have been reading the posts on lapbandtalk.com regarding Aetna, their process, denials, appeals, etc. The posts were about 50/50 on who was approved and who wasn't, who had to got through a lot to get the approval and so on. I was slightly worried, but still keep the hope that I would be approved the first time, even if it took a year. I have to say that I am very impressed by Aetna now that my surgery has been approved. I started the 6 month supervised diet in June, the last appt. was Nov. 26th. I went in to my lapband doctor on Dec. 2nd, turned in my records for the six month diet (yes, i handed it to them (doctor's staff) myself), talked to the doctor about what would come next, etc. The clinic turned all my paper work in, along with my dictation from the lapband, recomendation from my PCP, etc. on Dec. 10th. I called Aetna every Friday to get an update on my case. On Dec. 30th, about noon, an Aetna rep. called me and informed me that I had been approved. A few days later, a got my approval letter from Aetna.

The main purpose of the post is to encourage those going through the process with an Ins. company to keep pushing and have hope. If you get denied, try again. I truly believe that what really helped me get the approval the first time is the fact that I have a really good, experienced lapband doctor, and I completed everything required by the Ins. company BEFORE anything was submitted. The only thing Aetna did not have me complete is the Psy. Eval., because I don't have a history of mental illness....but, my lapband doctor requires it before surgery to make sure that the patient is prepared to go through with the surgery and to understand what is all involved post surgery.

Don't give up, if it is meant to be, it will happen.

Erika:thumbup:

Edited January 15, 200917 yr by mlonginotti

Thats what im going to try to do. I think documentation is the key. I have history of sleep apnea and asthma. Im going for a sleep study next month then im going to send all my stuff in. The doctor you are using should be able to help you do all the submission stuff.

Don't get discouraged. I have Aetna POS II also and thought it would be difficult trying to get approved. The doctor's office made sure that everything was done and all I did was submit my records from previous weight loss attempts (Weight Watchers and LA Weight Loss). My info was submitted first thing on a Monday morning and by 10:30am the doctor's office was calling to tell me I was approved! I've never heard of such a quick turnaround.:w00t:So again don't give up. Before you know it, you'll be getting approved too!!

What a sweet reply. Thank you for your encouragement:smile:

yes, please answer the exercise question. i am meeting with the dietician tomorrow and really wonder what I have to do for the exercise portion. thanks! (aetna pos 2)

yes, please answer the exercise question. i am meeting with the dietician tomorrow and really wonder what I have to do for the exercise portion. thanks! (aetna pos 2)

When I met with the dietician every month, we (or should I say I) developed goals that I would try to meet. I started out with exercising 3 times/week. Sometimes the goal was met and sometimes it wasn't. The main thing is that the dietician would document that I was developing a plan that I could stick with after surgery. Then, my doctor has a mandatory all day class that we have to attend prior to surgery and one part of it includes an exercise physiologist speaking to us about exercising and offering services to the fitness center, but I didn't have to meet with her pre-surgery unless I wanted to. All of this is documented as the "exercise regimen" portion that Aetna requires. Check with your doctor to find out what they would have you do. Hope this helps. Let me know if you have more questions.

Thanks so much for taking the time to explain the exercise regimen. It makes sense. I made several calls to Aetna today for clarification and was referred to the Information Line on the back of my insurance card. I spoke with a registered nurse who could not be specific either but between the two of us, we concluded that it is about making the effort and getting it documented by a "qualified professional" who would be the Nutritionist as you say or perhaps your PCP. In any event, I joined Curves tonight and had my first workout. Must admit it is pretty simple and fast and I will make the effort to go 3 times per week. This will be documented each time I go so I will have something to include in my package to send to Aetna. I made appts for Upper GI and Cardiologist appts and finally my next two Nutritionists appointments today. The woman who handles insurance at my doctor's office wasn't real positive about getting approval the first time out. I hate that. I am a glass half full person and will hope for the best. I am sure all of you went through similar feelings as I am. It's mentally exhausting. My feelings are up and down. I think every roadblock furthers my resolve to get this done. Thanks again to you and all for the really valuable and important information you all share.

I finally got the answer I was looking for from Aetna regarding the exercise requirements for the 3 Month Multidisiplanary Program. I emailed Aetna last night and here is the answer:

Thank you for using the Aetna Navigator website to contact Aetna Member

Services.

Clinical Policy Bulletin #0157 states the exercise program must be

physician-supervised and must be documented in your medical records every

visit. You can exercise at a gym, although your physician is required

to supervise you participation.

If you have questions, you can reach Member Services by logging on to

www.aetnanavigator.com and select "Contact Us." You may also call the

toll-free number on your member ID card.

Sincerely,

Internet Response Team

Aetna

Thought this might be helpful for anyone who had the same question.

Does anyone know what number to call at Aetna? My paperwork was submitted a few days ago and I want to call and bother them and see the status of my file.

Hey Ait,

The precertification # to Aetna is: 1-800-654-4602.

This is the number I called every other day after submission of my paperwork. When you call, select option 3. Have your Ins. card handy because they will ask for the ID # off of it. I always told them that I was calling to check the status of a precertification for an out-patient surgery. Some of the Rep.'s will ask what type of surgery, others won't. Most of them are really helpful. If they have recieved all your paperwork, they should tell you who your "nurse" there at Aetna is going to be, and give you all their info for you to contact them. They may also tell you to give the nurse "X" amount of days to get the paperwork looked over. I called on a Tuesday and the Rep. told me to call the nurse on that Fri. to get a status. I forgot to call, and the following Wed. (8 days later) an Aetna Rep. called me and told me I was approved.

Hope this helps.

Erika

Thank you so much! That was extremely helpful - I'm going to call right now.

Just called that number, and they told me they are a dedicated line for UPF (?) members and I'm not one - not sure what that is except that it meant she couldn't help me. Oh well...

ait, You should be able to call the number on the back of your card. Unfortunatly Aetna has a lot of phone numbers so your employer is probably a dedicated line so the number on your card should help. I hope that helps :w00t:

Julie

Thanks Julie. The number on the back of my card is the same general number on the website, which I guess means my company isn't big enough to warrant a dedicated number. I just tried googling Aetna precertification phone #'s but couldn't find anything.

Oh well.

I would still try to call it. Even if it isn't the right place they should be able to at least transfer you to the correct place or give you the correct phone number.

I got approved!!! Thanks all for your help-I'm so happy! The surgeon's office just called.