Your Aetna experience?

dmw · 04-09-2008, 12:22 AM

Hello.... I also work for Verizon.... in Durham NC. I am waiting for Aetna to approve. My BMI is 43. I have sleep apnea and high blood pressure. I did the 3 month prep regimen, saw the nutritionist twice. I am concerned I will be denied because I did not lose any.

dogluvr · 04-09-2008, 01:22 AM

Yup only 2 years weight history required now... they changed that like 2-3 weeks before my paperwork was submitted to them! I was very lucky because I only had BMI over 40 2005, 06, 07, and 08. It would have been slim chances for my approval. If you meet the qualifications on their website, which the link has been posted a few times on this thread, and jump through their hoops, then it is only a matter of time before your approval letter comes! I found my experience with Aetna RE: WLS to be pleasant actually and I have my approval letter hanging on my fridge lol makes me happy every time I see it. My BFF's BMI was only 35 but she did have mild diagnosed sleep apnea, and she was approved in 1 day. 1 day!

I hope everyone who has Aetna and is awaiting surgery stays positive- I practically lived and breathed this thread when I was going through my 90 day regime and awaiting approval. Thanks esp. to NeNe and lonestar for the support they gave to my nerves!!!

Oh, and to whomever has the BMI of 42 and no co-morbs, you still meet the qualifications!

Flowerpurr · 04-09-2008, 09:31 AM

Dogluvr,

I have a question for you. Do I have to get my suregon to submit all the paperwork or can I have my Dr.'s office do it for me? I am done with the three month diet and now my visit to the suregons office got pushed back. Did you have a letter from your suregon as well as your PCP?

dogluvr · 04-09-2008, 02:29 PM

I got a letter of reccommendation from my PCP, which was included in the mass of paperwork sent to Aetna by the surgeons office. I think the surgeon might have included a "letter of medical nessecity" or something like that. Once your 3 months is done your surgeons office should be sending Aetna all your paperwork, like, the day after! When you say your apt with the surgeon got pushed back, do you mean this is your first apt with him? They way it went with me was day 91 my surgery center faxed a pre-cert to Aetna, and Aetna then gave it to one of their review nurse, and then review nurse called my surgery center, and gave the insurance coordinator her fax number. Then the coordinator faxed everything to the review nurse.

Flowerpurr · 04-09-2008, 03:59 PM

Hi Dogluvr,

My suregons office wouldn't even see me until I was totally done with the diet and I was done yesterday. Than they wanted to make me wait a week to get all the paperwork sent to them. But now I have to wait for my first visit on the 21st. So I was just wondering if I could just have my PCP do it instead of the suregon but I am sure he needs to write a letter to. UGH!!! Aetna is such a pain.

dogluvr · 04-09-2008, 06:23 PM

Sounds like its not Aetna being a pain but your surgeon's office! I would be ticked if I were you and they bumped me. I would call and voice a complaint and get scheduled in somewhere earlier. Do they or do they not want your 18,000$? lol

Flowerpurr · 04-10-2008, 10:06 AM

Quote:

Originally Posted by dogluvr

Sounds like its not Aetna being a pain but your surgeon's office! I would be ticked if I were you and they bumped me. I would call and voice a complaint and get scheduled in somewhere earlier. Do they or do they not want your 18,000$? lol

Dogluvr,

Tell me aobut it. Now after doing the pre-op diet I have to go see the dietician alone and the exercise psychlogist and that's another $100.00 even though I see both weekly! UGH!!! This is becoming to much money. I better get approved. I have no co-morbities which is not good. But my BMI right now is 44.6 it was 49.8. So I hope Aetna just says yes because my bmi is still high! I am trying not to lose any more weight until I get approved for surgery. I don't want to give them a reason to say no.

dogluvr · 04-10-2008, 12:10 PM

Quote:

Originally Posted by dmw

Hello.... I also work for Verizon.... in Durham NC. I am waiting for Aetna to approve. My BMI is 43. I have sleep apnea and high blood pressure. I did the 3 month prep regimen, saw the nutritionist twice. I am concerned I will be denied because I did not lose any.

I gained 4 lbs during my 90 day regimen lol and lost 1 of those lbs the last apt. Dont worry!

temperance1972 · 04-10-2008, 07:01 PM

Wow that's good to know. Thanks for responding. That was my first post. How's everything going after your surgery?

dogluvr · 04-10-2008, 10:57 PM

Temperance,
I'm sure you'll have many posts to come! This site is a wonderful source of information, inspiration and support. I am doing well, thanks for asking! My port incision is the only one that still hurts. I havent had much of an appetite at all, which is cool, and I scheduled my first fill today for April 30th. Im getting an hour swedish massage on saturday Im just hoping I can lay on my stomach for it! If I were you Id be really excited being banded was one of the best decisions Ive made in my life. Id do it all over again, and again... and again.

BrooklynBandster · 04-10-2008, 11:22 PM

Hi, all - I just found out that I'm approved by Aetna! And they told me less than 24 hours after my file was submitted! This all comes on the heels of a four-month delay from my original surgery date due to other health issues, so I'm just really excited...I was expecting to be denied at least once, after all the horror stories I've read.

3-month multidisciplinary diet program, one year of doctor's visit, and a letter documenting my weight from an exercise therapist the year before. I'm so happy. And a little nervous. Now it's finally real.

tmbowe · 04-11-2008, 05:46 PM

How did you go about documenting your excercise on the 3 month multidisciplinary diet. I asked A representative at aetna and they told me I just had to tell my Dietician what I was doing and she could mark it down.. I would hate to get denied because I go the wrong information

BrooklynBandster · 04-11-2008, 09:14 PM

I've heard from some people that you don't need to actually go to the nutritionist/dietician every month, but I wanted to be on the safe side, especially because I didn't have a full weight history (it had to be five years when I started my diet). So I went to the nutritionist 1-2 times each month, and had the nutritionist write a letter documenting each of those dates and the major themes/behavioral changes we discussed. Done and done.

boomboom · 04-12-2008, 11:50 AM

I too was denied by Aetna. My problem was I fell below the bmi level within the two year period. My bmi was at 33.4 once within the 2 year period. Ive filed an appeal but I dont think it will do any good. Im getting no help from my surgeon. she doesnt do peer to peer. How did your peer to peer go did it help you. If so Im thinking of switching doctors.

Quote:

Originally Posted by yayamama76

Well, after going through all the hoops Aetna requires, I found out last week that I was denied.

They say I don't have the co-morbidities. But, I have sleep-apnea and high cholesterol, so I just don't understand. My BMI is 39. But, my policy says that your BMI only needs to be 35 if you have at least one co-morbitity.
My counselor at Lap Band Solutions scheduled a peer-to-peer consultation with Aetna, but they never called, so she is rescheduling it for next week. After all this effort, I am so depressed I don't even want to get out of bed.
Has anyone ever had any experience with these peer-to-peer reviews? I wonder if they ever change their minds once they've made a decision.

lonestar5212 · 04-12-2008, 11:55 AM

dogluvr - Glad to see you are doing well. I go for my first fill this Monday the 14th, but to be honest, I still am not really that hungry. Maybe once a day, late in the afternoon I feel a little, then I eat a little and that is that. Don't you just love how mentally you feel so good since surgery? I am so glad I did this.

And for all you Aetna people waiting, your day will come soon. What I learned through my journey with Aetna was this, if you meet their criteria, then you will eventually be approved. There is no way to predict how fast you will get an answer. Some people in one day, and some people 30 days, and everything in between. Hang in there and good luck.