Hello, anyone have aetna who has been approved ? I am currently finishing my 3 month dietician diet and was given an approval from the pychologist. I am really nervous because i think aetna sucks, anything i should do or expect when i finally submit the paper work?:frown:

I'm in process of the insurance struggle with Aetna right now. They changed some of the requirements for surgery--are being incredibly ridiculous about my supervised diet--and are making me go to an IOQ--which there isn't an IOQ in the state I live. So--if they approve, they will pay for me to fly to Vegas for surgery. I'm SO frustrated and scared. I'm ready for the help. Hope it happens for me.

Hi ahop, I was just denied by aetna after almost 8 frustrating months. Don't know if I should blame my doctors office or horrible aetna, who has consistently given me the run around. Sounds like your in the same boat!

all I can say is I never had 1 problem with Aetna. but they have so many different policies. have you checked out their Clinical Policy Bulletin for Obesity Surgery? If not go to Aetna.com up in the top right hand corner there is search box, type in 0157 this will give you all the criteria that they are going by to make there decision. it helped me navigate the system and understand why I had to go through what I did before surgery was even approved. my surgery was submitted on monday and was approved by wednesday but i did everything they wanted(if your surgeon is part of a weight management center I think it is easier because they know what your insurance needs/wants) & I had 2 comorbidities which I don't have anymore. I had surgery 4/13/10 @ was 230lbs I am now at 201lbs. hope this helps.

~ Shari

HI what plan do you have through Aetna?

I did my 3 month in Feb,Mar,Apr and when my doctor submitted her notes, the surgery center said it wasnt sufficient, but they wouldn't tell me what they needed to submit to Aetna. I'm going back to my doctor to have her include 2 years of weight history and more detail about my family history of cancer and diabetes, does anyone have a form or anything specific that Aetna requires to be put in writing from my primary doctor? Please help, so desperate. BMI is 47

Are you expected to lose weight on the 3 mo diet? Who weighs you, PCP or surgeon?

I did my 3 month in Feb,Mar,Apr and when my doctor submitted her notes, the surgery center said it wasnt sufficient, but they wouldn't tell me what they needed to submit to Aetna. I'm going back to my doctor to have her include 2 years of weight history and more detail about my family history of cancer and diabetes, does anyone have a form or anything specific that Aetna requires to be put in writing from my primary doctor? Please help, so desperate. BMI is 47

Mbesha01,

I submitted 6 months of weights on a diet, 1 weight for 2 previous years, a letter from my primary stating the need for this surgery and a diet history letter with weight loss or gains for the past 5 years. This letter also included co-morbidities and family history. That should do it with a BMI of 47 you shouldn't have any problems getting approved.

I submitted on Monday and was approved two days later. Surgery scheduled 10/12/10!

Hope this helps!

Melissa

wel aetna is great.we can easily approved.Claim Billing