Anyone have Aetna? Timeline question.

I know I can ask the doc, but I have a burning desire for more info at 11pm at night, so I'll ask here.

I have to do 3mos nutrition counseling and then Aetna has 30 days to approve the surgery.  Assuming everything else is taken care of, does the basic timeline look like this:

a)  Nutrition Consult. 30 Days. Nutrition Consult. 30 Days. Nutrition Consult. 30 Days. Then apply for surgery and get a date within the next 30 days. (~120 days total/maximum)

or

b) Nutrition Consult. 30 Days. Nutrition Consult. 30 Days. Nutrition Consult.  Then apply for surgery and get a date within the next 30 days. (90 days total/max)

or

c)  Something else?

 I'm trying to sort of plan ahead here with back-to-school and whatnot and it would help if I had some, even vague, parameters to factor in.

Thanks in advance!

 I don't have Aetna, but mine wouldn't allow me to submit until the entire time they asked was up.  For me it was 6 months.   After the 6th appt, the surgeon was then able to send it off for ins approval.   It CAN take 30 days for approval but mine took 1 week.   Some are quicker some take longer.   It actually goes really fast although in the beginning it seems forever away

 I had Aetna through Teacher Retirement System in Texas. I had my last nutrtition class in early Dec. 2010.  I also had my stress test on the same day.  I had done all the other required tests previous to that...psych eval, H. Pylori, etc. My paper work was submitted as soon as they received the stress test data. I believe it was faxed to the clinic the same day. I had approval in less than a week...about the middle of Dec.  At that point the last consult with the surgeon was scheduled  and then I scheduled my pre-admit with the hospital for the same day. I live 2.5 hours away from my surgeon's clinic.  Because my sister was coming from Kentucky to be with me during surgery and the week after and couldn't come until Jan. 29, these appts were scheduled for Jan. 14. On Jan 17 I started my 2 week pre-op liquid diet and had my surgery on Feb.1, 2011.  If my sister had been able to be more flexible on her end, I could probably have had everything done 2 weeks earlier.
Of course, a lot depends on the doctor's staff and how fast they submit the information to Aetna.  My clinic, the Davis Clinic in Houston, was always on top of things and as soon as they got the last piece of information they needed they submitted.

If you start the nutrition classes this month, you can probably be ready for submission of paperwork to Aetna by the end of July and possibly have the surgery the beginning of August depending on your surgeon's schedule.

It is a waiting game for sure and there are a lot of variables in our lives.  But even if you have to schedule later in August and miss a couple of weeks of school, it will be worth it for your health. A couple of people on my clinic's message board are also teachers. One scheduled his surgery the week before Thanksgiving week one year and went back to work after Thanksgiving. Another person missed a few days at the beginning of school last year as she was doing what it sounds like you are doing...trying to get it all done while off for the summer.

Good luck.  This time next year you will be very happy you have made this decision.

Aetna covered my RNY back in 2007.  I had to do a 3-month multidisciplinary program, meeting with surgeon, nutritionist, and exercise physiologist each month. Your first scenario is more accurate.  Be warned, though, that when they say three months, that actually means FOUR visits because they will ask you to keep a food log, so you need a 4th visit with the nutritionist in order to review your third month's log. So you need to add another Nutrition Consult to the back of the process before applying.

If you qualify for surgery based on your BMI alone, Aetna usually approves very quickly.  Mine was approved in 2 days.  If you have a lower BMI and have to show co-morbidites in order to qualify, it takes longer.

Lora

I started my process with Aetna on October 24, had my last dietician visit on January 27,was approved on February 9, and had surgery on March 13. Not a bad turn around, I don't think.

And as Lora stated, it is actually four visits with the dietician so keep that in mind, and Aetna will not pay for those visits and they will not let you do group visits like some other insurances will.

I was approved on BMI alone and was approved the day they had it scheduled for review. They were backlogged so it wasn't approved the day it was submitted, but as soon as they looked at it, it was a slam dunk, so to speak.

Good luck!

I began the process with Aetna last September, and did the 90 day program as well. After I fulfilled the requirements, they denied my first attempt.  I was over 100 pounds overweight ( BMI  over 40), had sleep apnea, and had HBP.

After the first denial, they asked to see two years of medically recorded weigh-ins. Thank fully I had my son two years ago so I was able to use my prenatal and postnatal weight ins. Once I submitted the two years required weigh-ins they denied me again, and stated RNY  was not medically necessary for me. 

I have a great bariatric team, and a great PCP ( who is also my obgyn)  they both wrote letters of medical necessity. Once both letters were submitted it took an additional two weeks to be approved.

So I started in Early September, approved in early March, and had my surgery in early April. 
The coordinator at my bariatric office stated that Aetna has been difficult to work within the last year.  Even out of state Aetna patients have to submit additional information after their first denial letter.

 

I have Aetna

The requirements for the surgery ar online.  I believe they want a 40 BMI or 35 with Diabetes.  It is a 3-6 month process.  Basically you need to get all the pre-stuff done (psych eval, EGD, Pulmonologizt / sleep test / Cario clearance, 3 Nutritionist meetings, and history of weight / diets).

One thing to check on, and this is for all insurance carriers, is your maximum out of pocket along with if bariatric is a separate coverage.

For me my max out of pocket for the year is $2500 but bariatric surgery is separate at 50% of the negotiated rate with a maximum of 10k for life.  What that means is The bariatric surgery is covered separately from the max out of pocket and will not apply to it.  At my hospital they charge 20k for the surgery but the Aetna negotiated rate was $2500.  i was responsible for half of that number.

Just be prepared to lay out about $3000-$4000 in the year of your surgery between copays and other costs.

Thanks.  Besides office visits, it looks like I'm only facing $500 for the actual surgery, which I am super thankful for.

Thanks for the replies!