| Medicare and Cigna. |
|---|
| Insurer Policy |
Medicare and Cigna. |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
55.5 |
| MD-supervised programs |
2 (24 weeks) |
| Policy |
Don't know |
| Source |
Louis 2 |
| AARP Medicare Advantage/Secure Horizons |
|---|
| Insurer Policy |
AARP Medicare Advantage/Secure Horizons (Diana C Bradley) |
| Insurer Status | Denied after appeal letter |
| Comorbidities |
GERD, Diabetes, Arthritis, Coronary artery disease, Depression, Hypercholesterolemia, Shortness of b |
| Source |
Diana B |
| Acordia |
|---|
| Insurer Policy |
Acordia (First Health) |
| Insurer Status | Approved after first letter (11/25/04) |
| Weeks to approval |
1 |
| Comorbidities |
Hyper tension, GERD, Gallbladder disease |
| Policy |
Must be medically necessary |
| Comments |
Great. |
| Source |
Holly D |
| AECOM Blue Cross CA |
|---|
| Insurer Policy |
AECOM Blue Cross CA (PPO) |
| Insurer Status | Approved after first letter (7/31/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
50.2 |
| Comorbidities |
sleep apnea, arthritis, breathing problems, high cholestrol, |
| Policy |
Don't know |
| Comments |
very pleasantly suprised how very helpful they were. |
| Source |
Mary J |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Exclusion |
| Source |
Cindy A |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
55.7 |
| MD-supervised programs |
1 (77 weeks) |
| Policy |
Must be medically necessary |
| Source |
Anne L |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after 2nd appeal letter (11-15-00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
14 |
| Pre-Op BMI |
67.2 |
| MD-supervised programs |
3 (80 weeks) |
| Comorbidities |
hypertension, chronic back problems, asthma, arthritis, immobility |
| Policy |
Written exclusion policy |
| Comments |
I have had Aetna insurance through my employer for many years and find that they are basically a pain to deal on many levels. However, they have been especailly difficult with this. Or maybe it just appears that way because I am disappointed at my declination. They consider the RNY surgery to be experimental and the code that it gets sent in under is very important. I guess there is a fine line between the codes and what they stand for. I have talked to them several times and as a general rule their responses are canned and it seems like they are read out of a book. Very inflexible. I did, however, find one person that was very helpful and we are re-submitting through her and she said she would "walk" it through. It remains to be seen if that actually happens. I'm trying to be optimistic. Make sure that you have a very detailed history of programs that you have been on, how much you lost, how much you gained back, how much it cost you and how many times you tried it. Make sure that you have as many doctors' letters detailing your weight loss struggle and the effects that morbid obesity is having on your health. The last line of my doctors letter stated, "Without this surgery Carletta will certainly succumb to this diease in the near future." Although it is a statement of fact it still had a powerful impact on me and I'm hoping it will have an impact on the insurance people making this decision as well. You really have to work with Aetna, it seems a little harder than some, because they are a little behind the times when considering this surgery. Be thorough, be persistant and have your doctor's insurance person try to remember if they have had other Aetna PPO patients approved and how they did it. It will help. Good luck. They are very picky about which medical code that the request is submitted under. They were extremely unresponsive throught the appeal phase. They told me they had submited my paperwork for medical review when in actualality they had not. I finally got a manager in HR at my company involved adn when asked about the approval they commented "It's only gastric bypass" Like it was not big deal. It is very disheartening working with them. |
| Source |
Carletta H |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (07/22/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
5 |
| Pre-Op BMI |
40.9 |
| Comorbidities |
Hypertension, Sleep Apena, Asthma, joint pain |
| Policy |
Must be medically necessary |
| Comments |
My surgeon's office was terrifficcccc. They've done it before and knew all the in's and out's. They did all the work and all I had to do was wait. It was so un-believale that they approved me on first try. I was admitted into the hosp. two weeks ago for asthma so that might have been a motivating factor.
|
| Source |
Roberta M |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (08/09/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
51.5 |
| MD-supervised programs |
4 (40 weeks) |
| Comorbidities |
Recurrent Incisional Hernias |
| Policy |
Must be medically necessary |
| Comments |
I never had to talk to them. The waiting was uncertain and the information given as to when all this would happen was unreliable but hey, they approved so no complaints so far. I think they stalled about typical but it did not go on long! The person at the Docs office was quite persistant and it worked! |
| Source |
Mary S |
| Insurer Policy |
Aetna (Managed Choice POS) |
| Insurer Status | Approved after first letter (08/06/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
58.1 |
| MD-supervised programs |
1 0 |
| Comorbidities |
arthritis, GERD, deep venous thrombosis |
| Policy |
Must be medically necessary |
| Comments |
They were great! However, my caveat is that my parent company is so large we have our own representatives at Aenta, so that may have had something to do with the ease of dealing with them. The sole complication was that they wouldn't approve until I'd met with my surgeon, which didn't happen until three days before the surgery because I was having it done out of state and had to fly to the place I was to have surgery (my home town where my parents still live). As soon as they got the okay from the surgeon though, they greenlighted the surgery in 24 hours. |
| Source |
Laurie M |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (10/05/00) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
45.4 |
| MD-supervised programs |
2 (21 weeks) |
| Comorbidities |
acid reflux, hypertension and hiatal hernia |
| Policy |
Must be medically necessary |
| Comments |
Aetna approved my surgery within 24 hours after they received the letter from my doctor's office. I can't believe how fast it was approved! |
| Source |
Sandy V |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (7/20/2000) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
60.8 |
| Comorbidities |
NO health factors at all. Surgery was preventive as my BMI was very high |
| Policy |
Must be medically necessary |
| Comments |
Dr. Chae's office sent the letter to Aetna around July 20th. I received a call that it was approved within the next 2 weeks. From that point, the surgery was scheduled rather quickly. In my case, I didn't have to push Aetna at all. They told me from day one (when I called to see if they did Bariatric Surgery) that the Dr.'s just have to prove that the surgery is necessary and not cosmetic. Since I weighed close to 400 pounds before the surgery, this was obvious. |
| Source |
Heidi M |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (4/20/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
9 |
| Pre-Op BMI |
54.1 |
| Policy |
Must be medically necessary |
| Comments |
It seemed like forever while waiting for an answer back from them, but they came through for me quite easily and I have had absolutely no problems with billing. I would recommend this insurance company. |
| Source |
Amy T |
| Insurer Policy |
Aetna (PPO open choice) |
| Insurer Status | Approved after first letter (12/09/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
1 (2 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Doctors office mailed information to them. I waited a week and called then I waited another week and called "still in review" by the end of 2 week I faxed a letter about myself and even though I think I am pretty healthy there are things I didn't previously think as co-morbids and now realize they are. I called beginning of 3 week and I was approved. Very happy with Aenta! |
| Source |
Lisa M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/02/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
58.4 |
| Comorbidities |
Hypertension |
| Policy |
Must be medically necessary |
| Comments |
Aetna was terrific and so quick! Of course I did a lot of prep work before I went to even see my surgeon. I put together a comprehensive history with all of the weight reduction efforts and comorbity informaiton. The surgeon sent this to Aetna along with their forms and this helped to get it done quicker. |
| Source |
Debbie G |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (01/24/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
53.3 |
| Comorbidities |
Swelling Feet, Swelling Knees, Back Pain, Acid Reflux, Severe Obstructive Sleep Apnea, Osteoarthriti |
| Policy |
Must be medically necessary |
| Comments |
I was very apprehensive about trying for approval again. At my last job I had a PPO and tried getting approved for over a year. WLS was excluded so I never had a chance. The first thing I noticed with my new job was that Aetna did not excluded it in their plan – and it was not excluded in my employer’s plan. I have a only been with Aetna since Oct 1, and I got approved after only 4 months with them. Originally Dr. Tillquist office sent my paperwork in on 12/13/00 – every time I called my case was still in review. Then all of the sudden when I followed up around 1/3/01, they claimed they were still waiting for the paperwork from my Dr. office. I guess they lost my file. I had to have Ilene in Dr. Tillquist’s office refax again and we started from scratch on 1/4/01. I was pretty sure that was a bad sign. I was so anxious I was calling almost everyday. They gave me the run around a little bit, but I’m sure some of it was them getting tired of m calling so much. Finally, about a week and a half later, I wrote a letter myself. I have to admit – it was a fantastic letter. If anyone needs a letter to use for follow up like I did or even for appealing a denial, let me know. I’ll send this to you in a heartbeat. I sent that letter on 1/12 and today (1/24) I was approved. Dr. Tillquist office was very patient with me. All in all, if we just look at the Jan day Aetna claims they got the first ppwork, it only took about 3 weeks to get approved. Even if we were considering it from the first day my Dr.’s office actually did send in paperwork, it was only about 7 weeks. |
| Source |
Kenya J |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/16/01) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
3 (35 weeks) |
| Source |
Janet Lynn S |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (10/31/01) |
| MD-supervised programs |
1 (16 weeks) |
| Comorbidities |
Congestive heart failure, Type II Diabetes |
| Policy |
Must be medically necessary |
| Source |
Gary N |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/30/01) |
| Surgery Type |
Laparoscopic Other |
| Pre-Op BMI |
49.4 |
| MD-supervised programs |
2 (156 weeks) |
| Source |
Dalena M |
| Insurer Policy |
Aetna (standard CHIP) |
| Insurer Status | Approved after first letter (03/04/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Comorbidities |
GERD, heel spurs |
| Policy |
Must be medically necessary |
| Comments |
aetna was great! i would highly recommend them. my surgeons office did all the work, and i never had to call aetna because of problems because there weren't any! |
| Source |
Keri L |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after appeal letter (04/03/01) |
| Source |
Cindy L |
| Insurer Policy |
Aetna (U.S. Health Care) |
| Insurer Status | Approved after first letter (04/19/01) |
| Surgery Type |
Laparoscopic Other |
| Weeks to approval |
1 |
| Comorbidities |
Sleep Apnea, Acanthosis Nigricans,Back pain,Morbid Obesity. |
| Policy |
Don't know |
| Comments |
Aetna, WOW!!! I had no problem, My doctors office did everything, that was the longest week of my life but WOW, my surgery will happen in may YEEEEHHHH!!!! I fully say yeah for Aetna, U.S Health Care. HMO |
| Source |
Judlissa L |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (05/17/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
54.8 |
| MD-supervised programs |
1 (16 weeks) |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
It was pretty easy. After the first letter they called and wanted more info (I was worried they wanted an actual letter from some docters about diets I had been on) but after Elizabeth spoke with them, she had me type up a list of diets I had been on and how much weight I had lost and regained and then she faxed that to them and they approved me the next day. Overall they were wonderful. |
| Source |
Corinna W |
| Insurer Policy |
Aetna (AETNA POS) |
| Insurer Status | Denied after appeal letter (10/08/01) |
| Comorbidities |
Hypertension, Sleep apnea pending, Countless diets, |
| Policy |
Must be medically necessary |
| Source |
Tonya M |
| Insurer Policy |
Aetna (pos) |
| Insurer Status | Approved after first letter (06/07/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
4 |
| Comorbidities |
Fatigue, bad gallbladder, recurrent hernias |
| Policy |
Must be medically necessary |
| Source |
Mary S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/10/01) |
| Weeks to approval |
1 |
| Comments |
I had no problems and did not have to deal with them at all. Susie in Dr Chae's office sent his letter along with a letter from my PCP. When she called the next Monday to follow up I had been approved. |
| Source |
April G |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (06/30/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
68.8 |
| Comorbidities |
Arthritis, knee problems |
| Comments |
I have heard that typically Aetna doesn't approve the first time the request was submitted. I don't know if it was due to my size or what, but my operation will be 100% paid for and I was approved the first time. |
| Source |
Suzanne C |
| Insurer Policy |
Aetna (Qpos) |
| Insurer Status | Approved after first letter (07/08/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
45.5 |
| Comorbidities |
Sleep apnea, type 2 diabities, back pain |
| Policy |
Must be medically necessary |
| Source |
Carl R |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (07/09/01) |
| Source |
Fiona R |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (07/20/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
58.1 |
| MD-supervised programs |
1 (48 weeks) |
| Policy |
Don't know |
| Comments |
I will update as soon as I know.. I have just begun this process.
The letter for pre-auth was only sent a week ago.
August3 2001
Well the ins company is requiring documentation of prior Dr supervised
attempts.
August 27th 2001
I was sent letter of authorization today!
Without the requested prior dr records.
September 25th,
The letter was only preauthorization for the VBG and not the RNY proceedure.. I am not sure if this has to be resubmitted or not. I will know this next week and will update then
October 15th,
Looks as if the surgery will be November 26th as scheduled.
|
| Source |
Kathi D |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (12/03/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
45.7 |
| MD-supervised programs |
3 (108 weeks) |
| Comorbidities |
High Blood Pressure, Arthritis,High Colesterol, Multiple Sclerosis |
| Policy |
Must be medically necessary |
| Comments |
I was pleasantly surprized, no problems at all. It seems that Aetna goes strictly on the BMI, if you're over 40 you are approved. My only complaint was that Dr. Tillquist staff did'nt send my papers in because they had other surgeries that were ahead of mine. I understand that is what they needed to do, but the waiting was killing me. |
| Source |
Vicki M |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | First letter sent - still waiting (09/19/01) |
| MD-supervised programs |
2 (44 weeks) |
| Source |
Kimberly L |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (02/04/02) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Comorbidities |
GERD, Arthritis, borderline hypertension, borderline diabetes, borderline sleep apnea. |
| Policy |
Must be medically necessary |
| Comments |
Aetna is a very good insurance company. They were prompt on their decision to cover the RNY. I had all my letters and ducks in a row prior to asking approval to Aetna. I had my physicians to write a letter of recommedations, for the surgery and all my previous attempts documented from my current physician of the last 3 years. I would recommend anyone contemplating getting approval from any insurance company to prepare in advance. |
| Source |
Karen H |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Denied after first letter (10/18/01) |
| MD-supervised programs |
3 (79 weeks) |
| Source |
Jc H |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after appeal letter (12/13/01) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
42.0 |
| MD-supervised programs |
7 (24 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I was turned down because my family doctor sent a letter instead of notes from my chart. The rason for this is that I didn\'t know that he hadn\'t documented the times that he had given me the American Heart Assoc. Diet. It is extremely important that it is documented. Had I known this it would have made a world of difference.
It was turned down three days after it was sent in. So that means, if I had sent the correct info I could have been approved in three days. Ruth did inform me that it had to be the notes from your chart or it would be denied and that is exactly what happened.
However, I had to get documented proof that I had doctor assisted diets and proof of attempted weight loss. Once this was sent in it took two weeks to get the approval. Thank God my old OB-GYN had everything in my records but that had to be retrieved from storage which took about three weeks because they had difficulty finding them.
Aetna HMO has gotten pretty strict about the documented proof. Also I called several times and each time it was a different person and each time a different answer. One day I was told I hadn\'t been approved and the next day I was told that I had been approved the week before. I was approved in two weeks after my appeal was filed but I was told I wasn\'t by several different people because they didn\'t take the time to read the info on the computer. Thankfully, one girl did her job and made my day and my life wonderful! |
| Source |
Robbie B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (1/24/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.8 |
| MD-supervised programs |
3 (78 weeks) |
| Policy |
Must be medically necessary |
| Comments |
1/21/01 still waiting for approval-but Dr. Tillquist's office has not sent insurance papers yet-there are patient's ahead of me. 1/24/02 They approved me in 3 days-I never had to call them Eileen took care of everything. I am very pleased with Dr. Tillquist's office staff. |
| Source |
Jamie H |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (01/07/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
48.6 |
| Comorbidities |
Diabetes, sleep apnea, asthma |
| Policy |
Must be medically necessary |
| Comments |
Insurance company was great. The only challenge I had was getting the surgeon's office to send in the paperwork. This took them over a month. It only took the insurance company a week to approve it. |
| Source |
Denice L |
| Insurer Policy |
Aetna (ups) |
| Insurer Status | Approved after first letter (03/19/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| MD-supervised programs |
2 (58 weeks) |
| Source |
Jeff V |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (05/19/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
46.3 |
| MD-supervised programs |
2 (32 weeks) |
| Source |
Deb A |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after 2nd appeal letter (05/31/02) |
| MD-supervised programs |
1 (44 weeks) |
| Source |
Denise Y |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (06/05/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
46.8 |
| Comorbidities |
Asthma, joint pain, infertility |
| Policy |
Must be medically necessary |
| Source |
Amanda R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/09/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
1 |
| MD-supervised programs |
1 (20 weeks) |
| Comorbidities |
arthritis and strong family history of heart disease, hypertension, and diabetes. |
| Policy |
Must be medically necessary |
| Comments |
Dealing with Aetna HMO was very positive. They approved me to have the surgery within one week. I was lucky though, as they required that I had to be on a medically supervised program within the year prior to asking for the surgery... lucky for me I had been. I was able to provide the doctor's records, and was approved immediately. It's important to note, that had I not been in a physician supervised program, I would not have been approved. Also, when I called to initially inquire on their coverage policy for this surgery, they neglected to tell me that this was their policy, so I feel I was pretty lucky. |
| Source |
Connie D |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | First letter sent - still waiting (08/20/02) |
| MD-supervised programs |
1 (26 weeks) |
| Source |
Mary M |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (07/21/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
42.7 |
| MD-supervised programs |
2 (6 weeks) |
| Source |
Lynn F |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (09/04/2002) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
38.4 |
| MD-supervised programs |
2 (208 weeks) |
| Comorbidities |
Hypertension, sleep apnea, joint pain, depression, stress incontinence |
| Policy |
Must be medically necessary |
| Comments |
They SEEMED nice enough in my dealings with them however, my surgeon's office reported that they denied receiving faxed info twice and I believe this was their stalling method. They definitely responded to persistence. I'd recommend having a pit bull of an insurance person at your surgeon's office deal with them. |
| Source |
Paula H |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | First letter sent - still waiting (08/24/02) |
| MD-supervised programs |
1 (10 weeks) |
| Source |
Carol C |
| Insurer Policy |
Aetna (US Healthcare thru UPS) |
| Insurer Status | Approved after 2nd appeal letter (09/10/2003) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
48 |
| Pre-Op BMI |
49.1 |
| MD-supervised programs |
3 (130 weeks) |
| Comorbidities |
High cholesterol , incontinence, spinal stynosis, degenerative disc disease,arthiritus, back surgery |
| Policy |
Must be medically necessary |
| Comments |
Well its 8 days away for the big day but guess what still do not have approval the wanted more wl atemps medically suprevised well I was on meds thru my dr for 3 1/2 years till 6/00 and the want more then 6 months and they dont go back more then 2 years.... then they have came back and the first person has said that they couldn't make the decision so they had to send it up to someone hire.. so maybe by my date I will know.. 12/02/02 nope as you know it didn't go still waiting for and answer should hear something in the next few weeks. 09/12/2003 well Aetna came thru almost a year later but it finally did it has beed hard to deal with but I've made it I'm glade finally , all I can say is check with them see exactly what you have to do and do it, they stand to there criteria strong. Thank you to natalie and Patty at Aetna for making the papers get to where they need to. |
| Source |
Denise Y |
| Insurer Policy |
Aetna (PPO Open Choice) |
| Insurer Status | Approved after first letter (4/23/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
5 |
| Pre-Op BMI |
40.3 |
| MD-supervised programs |
2 (100 weeks) |
| Policy |
Must be medically necessary |
| Comments |
They really don't give you any information when you call other than it is under review. I wish they had some sort of web page where you could view the status more closely. I am greatful that I was approved the first time but my goodness that was the longest 5 weeks! My packet was very detailed and I even included my first entry on my profile from here at Ob Help. Don't know what was the clencher and I guess I never will but at least I am approved. Now I have to wait for the snail mail to bring my confirmation letter. They won't fax me verification due to privacy issues. Seems like they could at least e-mail it to me. Oh well what's a few more days. |
| Source |
Susan M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/12/03) |
| MD-supervised programs |
3 (332 weeks) |
| Source |
Gary V |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after appeal letter (12/02/2003) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
5 |
| Comorbidities |
Sleep apnea, mild hypertension |
| Policy |
Must be medically necessary |
| Comments |
Dealing with the first Clinical nurse that got my file ready for the Dr. that was reviewing my file was not a fun experience. She was not helpful, and basically told me before the file was even reviewed that I would get denied. Two days later she called me back to tell me I was denied. I was so worried that the appeals person that I would get was going to be just as awful, but I could not have been more wrong. She was so nice and helpful, and said, fax me your appeal letter, and the last notes from your PCP, and we'll get you taken care of. A week and a half later I received a letter in the mail saying they reversed my denial. I was beside myself!! :) It hasn't sunk in yet, but I can't wait to start my life all over again!! |
| Source |
Angela |
