Your Aetna experience?

skculpepper · 12-11-2007, 11:36 AM

How long did it take? I am just curious, it has been a week today for me! I am jealous, best of luck Melissa. Are you already scheduled for surgery?

swstacey1977 · 12-11-2007, 01:13 PM

Skculpepper, have you called Aetna yet to check on the status of your paperwork? i called them 2 days after i knew it was faxed to them and that is how i found out i was approved. the lady told me over the phone. I think that Aetna is good about approving people.
Good luck Melissa and welcome !!! i have had my band since 11-30-07 and i love it. lost 11 pds so far. can't wait to get that first fill and really start losing...hopefully :) good Luck on your journey

mmwhitehead · 12-11-2007, 06:02 PM

I had been concerned about the weight loss history but your posts have helped. I had my consultation yesterday and will start my supervised diet in January. I know at almost every doctors appointment since 2003 my doctor and I have discussed my weight like if I have gained or lost. So I am glad that I can ask her to summarize my weight lost attempts.

JDUB0414 · 12-11-2007, 08:12 PM

Congrats Melissa, I'm happy for your approval. They've had my paperwork for two and a half weeks. I just received a letter today stating they needed the five year weight history for both my husband and myself. I am so upset, because I thought my doctor sent that info to the weight loss center. They said they will fax it over ASAP. I'm not worried about getting the history for myself, but I am for my husband. He hasn't been to the doctor like that. We are trying to figure out something.

Do you know if they will just deny him, or will they look at the file and determine with what they have?

nikki2001 · 12-11-2007, 09:30 PM

Well I have Aetna PPO and it took them only 1 week to approve me!!

MELISSAV2943 · 12-12-2007, 03:54 PM

Quote:

Originally Posted by skculpepper

How long did it take? I am just curious, it has been a week today for me! I am jealous, best of luck Melissa. Are you already scheduled for surgery?

The paperwork was sent in on 11/19/07 and I got the approval letter in the mail on 12/6/07. :clap2:

My surgery has NOT been scheduled yet ... I only have 1 more thing to do before I can be scheduled ... an EGD scope
My doctor likes to do one 2 wks prior to the actual surgery so I figure it will be in Jan. 2008.

Melissa

raya · 12-12-2007, 06:25 PM

I started the "intensive" supervised weight loss program after my initial consultation in October. I met with the nutritionalist in October, November and December 1st. Had already done my labs and psych eval and had a 7 year history of sleep apnea. My doctor turned everything into Aetna on 12-3 after my last nutrition appt and Aetna came back for the 5 year weight history and list of diets tried on 12-5, which I was able to provide to them 12-6. They approved me 12-10 and I had the surgery 12-11 (yesterday). good luck to you all!

dogluvr · 12-18-2007, 08:32 PM

Quote:

Originally Posted by raya

I started the "intensive" supervised weight loss program after my initial consultation in October. I met with the nutritionalist in October, November and December 1st. Had already done my labs and psych eval and had a 7 year history of sleep apnea. My doctor turned everything into Aetna on 12-3 after my last nutrition appt and Aetna came back for the 5 year weight history and list of diets tried on 12-5, which I was able to provide to them 12-6. They approved me 12-10 and I had the surgery 12-11 (yesterday). good luck to you all!

Your experience gives me hope!:clap2:

skculpepper · 12-19-2007, 09:19 AM

How long did it take you to get approved, it's been 2 weeks and I have not heard anything yet, should I be getting nervous. I did the supervised diet with nutritionist, 5 year weight history, BMI-46, and Sleep Apnea. Best of luck to you!!

SpecialK · 12-19-2007, 01:09 PM

I'm trying to be sure I also have the same things lined up that I need to go approved. Aetna PPO Choice II program.

I'm finishing a cardiology clearance, have my sleep clearance, and finishing psych clearance in January that is required.

I am having my PCP send any records she has from the past 5 years where we took weight and heights (she does every visit) and notes from any visits where she discussed my overweight and diet needs, and sending that to the surgeon's office who will do the submittal to Aetna.

Now I'm trying to decide if you're saying if you have 5 years of PCP records documenting weight issues with hopefully a scattering of notes she made about my weight and advising me to diet, will that be enough to not have to do 6 months of physician supervised weight loss? Just to be sure I am scheduling a January PCP visit to keep talking with her each month about weight and diet so she knows it has to be documented in her notes. I had a physical in November, sent her the request for records for the surgeon's office in December and now have a January appointment. I'm hoping that counts at least as 2 of my 6 months of appointments.

Any comments or help you can provide will be greatly appreciated.

SpecialK · 12-19-2007, 01:24 PM

I had my initial nutrionist consultation Dec 18 with my surgeon's hospital bariatric program nutrionist. I am hoping that counts as 1 of my 'intensive' nutrionist counseling appointments. I had to provide her food journals, information on diets tried including ones where I took Phentermine (not Phen-fen), trying WW actively now, etc. She was pretty cool about things. Told me diet expectations.
If I need to do one nutrionist appt for January and for February before submitting to Aetna, let me know so that I get the 3 done.

raya · 12-19-2007, 08:29 PM

SpecialK-
Sounds like your documentation is great! All you need is just something from a Dr's office showing your weight once for each of the past 5 years (2003-2007). One of mine was just going for a flu shot, they're just looking for proof that you didn't just become overweight that you have been struggling for 5 years or more. As for your nutrionist visit, yes that should count because that is the same as what I did. I think it is important to use someone like that who works with your Dr. because a lot of this has to do with how reports are written. As I said before I met with the nutrionist in October a few days after my initial consult and then again in November and then again December and had my surgery 12-11.

Good Luck!

raya · 12-19-2007, 08:35 PM

SKCulpepper-

I pushed it hard because my surgeon was only doing surgery one day in December because of the holidays and all of my deductables were met. So I submitted on 12-3 called and found out I needed the 5 year history and diet history on 12-6, submitted both items to them on 12-7. On Monday 12-10 I kept bugging them (my surgery was scheduled for the next day) and I was just about to scrap it and wait till January and I got approval that afternoon. I found out who my claim manager was for this rather then just calling the 800 number and talking to who ever answers. They helped me quite a bit since I had a surgical date.

good luck-
Ray

SpecialK · 12-19-2007, 08:59 PM

Thanks Ray for confirming that I just should get a January and February nutritionist appt lined up and then I should be close for maybe a March approval & banding instead of thinking I had to wait 6 months! Woo Hoo!:clap2:

skculpepper · 12-20-2007, 12:59 PM

I got my insurance approval yesterday. I am so excited. I can hardly believe it. I have an appt. on January 10, with Dr. Marsden (Texas) and they advised I should be able to have the surgery towards the end of January. What a wonderful Christmas and New Year it will be with a "NEW ME".

Your Aetna experience?

Thanks for info