Aetna Approval needed

The Nurse Coordinator has told me she now has all the required paper work needed to send in my information to request my LAP-BAND® Surgery next week to Aetna.
I am now at the stage of waiting patiently for Aetna to approve my claim for LAP-BAND® surgery. I have completed or met all of the requiremenths set forth by Aetna. I have sleep apnea, type II diabetes, High Blood pressure, Congestive heart failure, AFibb and have proof of a BMI of greater than 40 for the last 5 years. The only requirment I am worried about is the 3 months of supervised exercise (3 times a week). Because of my AFibb my Cardiologist would not allow me to do any cardio work that would elevate my heart rate above 120 bpm. The Nurse suggested I go to physical therapy where the Staff could monitor my heart rate as I worked out. I had to get a refferal for each visit to the Rehab clinic to cover this requirement.
I am concerned that Aetna will say this was not enough exercise to meet the requirement. Has anyone had a situation similar to mine?
I was a little apprehensive at the beginning but find myself getting excited at the prospect of finally having some help to correct my life long battle with obesity.
I would like to thank everyone for sharing their experiences so us "Newbies" know what to expect in our journey to LAP-BAND® surgery.

bigunc,

I'm a newbie also. I just got approved Friday. When I did the six month dr. supervised visits, all my dr. did was put on their that I did a 15 min treadmail workout three times a week. Hopes this helps.:)

I'm a newbie too.. just joined yesterday.. but I've been preparing for this for over 6 month now.. (although it feels like I'm been waiting all my life). I have Aetna and I followed all their requirements now I sit and wait for my coordinator to tell me she's ready to submit the request for approval. Like JDUB414 my dr. also put down all the monthly report that I did a 15 -20 minutes treadmill workout 3-4 times a week. He also but down that I was on diet pills and a low cal diet. (1500-2000) a day. What bothers me so much about Aetna is that they require you see a dietitian but they wouldn't cover the charge unless I paid my medical deductible first. ...
Oh well right now I'm just preparing myself mentally for the surgery (being optimistic that they WILL approve) & reading all I can on this site to help me out!!.. good luck to you and i hope for the best !!

Ok now I'm worried! I have Aetna PPO also all I was told I needed was a 5 year weight history and a 6 month supervised diet. I also need a supervised excerise routine for 3 months? Does Curves count?

speaking as someone who's had the surgery (no, I didn't have Aetna) No matter WHAT you have to go through... it's worth it. A year from now when you are down 75-125 pounds, you will look back and say.... it doesn't matter what I went through. DON'T GIVE UP!

jess4houston-I think curves will only count, if your doctor puts that in your file during your visits. I have a form that I got from another member on here that my doctor filled out. We sent that instead of all her medical notes. It worked.

Annielkd-thanks for your motivating words. I cant wait!!!

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3/19/2008-Surgery Date

I an worried too. I was told the same thing by Aetna and did what I understood was the requirements. Then when my doctor filed, I was turned down and told by Aetna that I must go through another year of supervised weight loss program by doctor. I am getting very discouraged.

Bigunc... We almost have identical med history and age. I am close to going to my initial eval. I actually posted earlier today about Aetna and the process. I am curious to follow your progress. I haven't heard the exercise requirement but of course i am very new. I am assembling a series of questions for my surgeon's visit in 2 weeks. I'll be sure to add this. Tom from Ohio

Should I get a letter from my gym that I have been a member since 2004 for my doctor to put in my file.

In dealing with Aetna and knowing what they're expecting according to their bulletin, you've gone above and beyond. I think you'll be doing just fine. You might need a few more months of diet and exercise, as Aetna requires 6 months in the past 2 years, but only 3 have to be consecutive (this is for a typical standard approval) Now, you may have extenuating circumstances that may change that - but you look like you're pretty well set.

Thread Starter

I heard from the Surgeons office Friday that Aetna has approved me for Lap-Band® surgery. I am now waiting to get with my Surgeon to set up the actual surgery date. The Nurse said I should have a date no later than the early part of Feb. for my surgery.

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"Big Unc"
Banded 2-25-08 (390 lbs)
Highest / 1st consult / current / goal
451 / 413 / 344 / 190
59.5 / 54.5 / 45.4 / 25.1

Nice to hear! Good luck on the rest of your journey.

yes curves counts. thats what I did and was approved by Aetna HMO

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Surgery date: January 23, 2008
I joined the LAP-BAND®

Jesus said "I am the way, the truth and the life, no man comes to the Father except through me (John 14:6).

I think that as with most anything else in big companies, it depends on who your case worker is. It's like if you call the phone company 3x you'll get three different answers. Unfortunate but true.

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Surgery date: January 23, 2008
I joined the LAP-BAND®

Jesus said "I am the way, the truth and the life, no man comes to the Father except through me (John 14:6).

Welp. I got denied on my appeal. My doctor's notes weren't thorough enough. I'm trying to see if he'll add additional notes, as they said they would take those. We'll see.