Aetna PPO

Anyone had any problems with their surgery being covered by Aetna? Any restrictions etc?

How did it go?

I have aetna ppo also. I know they cover the surgery. 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:)

I was denied last year 2 times, so I have now done the 6 month doctor supervised diet. I have had the sleep study done, now I wonder what the reason will be for the next denial?

Be careful. In some cases after 3 denials you have no recourse at all and the case is closed. Might be time to get an attorney. Try Walter Lindstrom at www.obesitylaw.com

Oh well that will just be great. Why do we pay for insurance if we can't use it?

.
It's a contract; once you sign up for an insurance you have to play by their rules.
But sometimes you need to get an attorney to make sure they are playing by their rules as well.

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Originally Posted by haloep I was denied last year 2 times, so I have now done the 6 month doctor supervised diet. I have had the sleep study done, now I wonder what the reason will be for the next denial?

Why were you denied the first two times for? I'm only wondering because I also have Aetna POS. I am on my second month of a three month evalution and I have to go back and redo the sleep test with the c pap.

Here is the link for aetna's criteria. http://www.aetna.com/cpb/medical/data/100_199/0157.html

I'm wanting to do the 3month plan, but my surgeons office tells me that NO ONE in thier program with aetna has ever been approved for the 3month, only the 6 month. I called aetna to see if they could explain their criteria and they can't, they told me that they could show me where the criteria was (link above) but that no one at aetna is allowed to explain it. Its absurd.

Has anyone been approved after the 3month supervision?

OMG! I hope I don't have any problems getting approved, My doctor knkows my insurance and he didn't anything. I think I will give them a call.

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Originally Posted by lexysmommy Here is the link for aetna's criteria. http://www.aetna.com/cpb/medical/data/100_199/0157.html I'm wanting to do the 3month plan, but my surgeons office tells me that NO ONE in thier program with aetna has ever been approved for the 3month, only the 6 month. I called aetna to see if they could explain their criteria and they can't, they told me that they could show me where the criteria was (link above) but that no one at aetna is allowed to explain it. Its absurd. Has anyone been approved after the 3month supervision?

I have Aetna PPO and I was approved fairly easily. But I met all of the required criteria...they stressed that the 6 month doctor supervised diet was the most important. Luckily, I had been working with 2 different docs for 2 years so they counted that. The hardest part for me was getting all of my records together. Good luck!!

Now I'm nervous I don't want this to set me back another 3 months. I don't have any major health issues other that my bmi is over 50 and I have sleep apnea. You would think that the doctor should know more or less what you need when you begin the program don't you think?

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Originally Posted by JDru I have Aetna PPO and I was approved fairly easily. But I met all of the required criteria...they stressed that the 6 month doctor supervised diet was the most important. Luckily, I had been working with 2 different docs for 2 years so they counted that. The hardest part for me was getting all of my records together. Good luck!!

I hope that the 3 month program is enough to get you approved! I made sure I gave the insurance company more info than was requested. Make sure you have you primary care doc write a letter of support that lists you sleep apnea, bmi, medications, etc and that Lap Band would drastically improve your quality of life. Keep us updated!!

I hope do also. I was so worried that I called my doctor today and they said that Aetna POS requires you to go through a 3 month program with the doctor and also a nutrionist. So I hope I will have everything I need.

Quote:

Originally Posted by JDru I hope that the 3 month program is enough to get you approved! I made sure I gave the insurance company more info than was requested. Make sure you have you primary care doc write a letter of support that lists you sleep apnea, bmi, medications, etc and that Lap Band would drastically improve your quality of life. Keep us updated!!

Good luck!! I'm sending good thoughts your way. :)