Aetna

cutecarmelnurse · 01-07-2007, 12:59 PM

HAS ANYONE HAD ANY EXPERIENCE DEALING WITH AETNA FOR BANDING?:help:

**Alexandra** · 01-07-2007, 01:10 PM

I've had LOTS of experience dealing with Aetna for banding, none of it good.

The two most important questions you have to have answered are:

Is banding covered under your contract?

Are you medically qualified for banding or other bariatric surgery?

If both of these are yes, you will be able to get Aetna to pay for it but there are hoops they'll make you jump through. But if either of these are no, you will have a problem.

bwaydiva · 01-07-2007, 03:36 PM

Aetna told me that I would have to do a three month doctor supervised diet prescribed by a nutritionist. It had to be documented in my chart and THEN they would approve the surgery. Currently, I am waiting on approval. Hope this helps. Sheila

P.S. I have Chickering which is a sub-company of Aetna. Chickering is the student form of Aetna so maybe the reqs are tighter. Good luck.

JDru · 01-07-2007, 04:07 PM

I have Aetna and it was relatively easy to get approved. However, I have Aetna PPO not HMO so that may have made the difference.

There were certain criteria I had to meet in order for the surgery to be deemed medically necessary. I had been working on my weight with 2 different doctors for over 2 years so I had the medically supervised diet taken care of. I had to have a BMI of at least 35 with co-morbidities (I have high blood pressure, insulin resistance, high triglycerides, BMI of 39.9) or a BMI of 40. They also required a psych eval and a nutrition eval. I also included a letter of support from my PCP and I think that helped. There are also blood tests that need to be submitted.

First I would call customer service and make sure LAP-BAND® is covered by your specific benefits and document who you talk to in case you run nto problems later. Start making appointments to get your blood drawn and evals done and request you records.

Good luck on your journey!! Let us know how it goes...

SonjaS · 01-14-2007, 12:21 PM

I have Aetna as well. I am doing my 2 month of supervised diet. I am a light weight so I hope not to lose too much. My BMI is 38 and I am tired of dieting and 'regaining' more weight.

Minniegiggl · 01-30-2007, 05:39 PM

I have aetna ppo also. I know they cover the surgery. i qualify, i have diebetes and at 40bmi. but, when u call they won't tell u the criteria. so, they tell u your dr. should know. my surgeon appt is in March. Hr said if i get denied after they put it in.. they will corporate then.. to find out exactly. I think insurance is going to hold me back. good luck.
Minnie:)