Aetna Insurance

sfsugrl26 · 07-02-2008, 03:00 AM

Hi I was just wondering if anyone had aetna insurance its a ppo and I have the Aetna select plan where I can only go to in network providers. I am in the process of getting a network deficiency because there is no doctors in network that perform the sugery in my state at all, so my question is how is aetna it has been a nightmare so far trying to deal with them. How long does it take for them to approve and also does anyone know if I went to the doctor every month sometimes 2 times a month for 7 months and got my vitals taken and was put on weightloss pills if this would qualify for a medically supervised diet I also have gym logs to confirm I was working out.

ocbreeze4u · 07-02-2008, 09:41 AM

I have Aetna PPO Choice and I noticed that most doctors that are actually in the network do not show up in Aetna's Directory. Have you called Aetna and asked them for a bariatric surgeon in your area? If they do not have one within a reasonable distance they have what is called rual service providers where they will pay for an out of network surgeon at an in network price. They also will reimburse you for medical related travel expenses if you need to go far for treatment. Call them and ask.

As for the weight loss pills. Aetna requires 6 months of a Doctor supervised diet within the last two years. I was going to a weight loss clinic for over a year that was pills, herbal suppliments etc. and a doctor oversaw the clinic so it counted. Just be sure that you get copies of your patient log that shows you weight loss history and they will take it along with a statement from the doctor that you were educated on better eating habits and exercise...that is all they need.

Aetna can take less than a week to approve however, mine took 6 month due to two appeals but I won last month and my surgery is this month so good luck and contact me if you need any further assistance. I know Aetna inside and out.

orea15 · 07-02-2008, 10:09 AM

I have Aetna Open Access HMO. My surgeon's office told me that Aetna usually responds within 2-3 weeks and that was exactly how long it took for my approval. The waiting was the hardest part. If you have any questions about what they require and what they will accept, call Aetna and ask. I did that when I needed to have the psych assessment. I needed to know exactly what kind of provider to make an appointment with. (A clinical psychologist)

Orea

ocbreeze4u · 07-02-2008, 11:27 AM

Click on the thread below, this is Aetna's Gastric guidelines for surgery. Trust me, I went through two appeals and they do not deviate from this list. Again, I went to a Dr. office that prescribed pills and tracked my weight (documented) and when it came time for me to apply for my lap band he also wrote a letter that I received nutritional counseling and exercise guidelines and it worked. My denial was due to a completely separate issue and I had it over turned.

Click here
Obesity Surgery

sfsugrl26 · 07-04-2008, 05:40 PM

Thank you both for responding this defenitely helped me out I have been trying to get this surgery for the past yr and was planning on getting it on united health care which is alot easier but my fiance switched jobs and now I am stuck with my aetna it has been really difficult trying to find out what I needed to do but your information helped alot because aetna has not been very helpful and I continue to hear different stories from them on what I need to do so I appreciate you both :biggrin2:

june11th · 07-04-2008, 06:02 PM

Hi .i have Aetna Open Access and had my surgery approved without any problem even though I did not have 100 excess weight ,but somw other medical problems

sfsugrl26 · 08-21-2008, 01:57 AM

well once all my info was sent into aetna they approved my band in 4 days it was ridiculously fast and after i spoke to the right people it was seriously smooth sailing now today is surgery date and of course i have the pre surgery jitters and all but I know afterwards this will be the best thing for me but i am still terrified about the whole anethesia and slicing my body open deal