| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open RNY |
| Comments |
It was approved with no problem.. As long as you
are 100 lbs over your ideal weight. It was not
in my policy exclusion list. |
| Source |
Caren M |
| Insurer Policy |
Aetna (Managed Choice) |
| Insurer Status | Approved |
| Comments |
After receiving the dr.'s request, they required proof of past failures which I had already had forwarded to my dr. The approval followed shortly thereafter. |
| Source |
Mary H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (May 1999) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
44.6 |
| Policy |
Must be medically necessary |
| Source |
Dee B |
| Insurer Policy |
Aetna (Epo) |
| Insurer Status | Approved after first letter (05/19/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
hypertension |
| Policy |
Must be medically necessary |
| Comments |
It was great and only took one week till approval. I was worried because Aetna recently changed there policy but no problems here. I'm so happy. |
| Source |
Carrie D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/08/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
48.0 |
| Policy |
Must be medically necessary |
| Comments |
I didnt have a real problem with Atena. I did find that their customer reps think this type of surgery is similar to Liposuction and quickly reply with " we dont cover cosmetic surgery!" |
| Source |
S W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/12/00) |
| Surgery Type |
RNY |
| Pre-Op BMI |
48.5 |
| MD-supervised programs |
1 (20 weeks) |
| Source |
Cecil B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/07/01) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
45.3 |
| MD-supervised programs |
2 (68 weeks) |
| Source |
Rita K |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/16/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
6 |
| Pre-Op BMI |
45.8 |
| Comorbidities |
sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
Very nice, they didn't mind that I called them almost everyday checking on my status. |
| Source |
Melissa M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/24/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
55.1 |
| MD-supervised programs |
2 (11 weeks) |
| Source |
Donna S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/17/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
57.2 |
| Comorbidities |
sleep apnea,arthritis,high blood pressure,heart |
| Policy |
Don't know |
| Comments |
My Doctor took care of all of that . |
| Source |
Connie G |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (7-1-02) |
| Weeks to approval |
1 |
| MD-supervised programs |
2 (11 weeks) |
| Comorbidities |
ARTHRITIS,HYPERTENSION,LUPUS AND BACK PAIN |
| Policy |
Must be medically necessary |
| Comments |
IT WAS GREAT NO PROBLEM.THEY ANSWER QUICK.
I RECOMMEND THIS INSURANCE. |
| Source |
Luz N. M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (I'm not sure of exact date) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
43.4 |
| Comorbidities |
diabetes, hypertension,arthritis |
| Policy |
Don't know |
| Comments |
No problems with them, They haven't stalled with me at all. In fact they believe in preventative medicine. They like for you to do things to prevent helth problems. I would highly recommend them. There is no deductible,no pre-existing conditions to worry abot and you are covered from the first day they take your money. |
| Source |
Lois W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/13/01) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
53.1 |
| MD-supervised programs |
1 (50 weeks) |
| Policy |
Must be medically necessary |
| Source |
Genevieve L |
| Insurer Policy |
Aetna (Citigroup HMO) |
| Insurer Status | Approved after first letter (09/25/02) |
| Weeks to approval |
3 |
| Pre-Op BMI |
50.4 |
| MD-supervised programs |
1 (112 weeks) |
| Comorbidities |
Morbid Obesity |
| Policy |
Must be medically necessary |
| Comments |
Oddly enough, I dont have much to say about this. It was all cut and dry. No mess...No fuss. No extra test required as some ins. companies require. All the tests done at the participating hospital was covered 100%. I believe my out of pocket expense has been under $100. The surgery itself is also covered 100%. I had no trouble fnding a surgeon that I was comfortable with, and I am glad I chose Dr. Pasupathy. |
| Source |
Melanie S |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (04/23/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| MD-supervised programs |
1 0 |
| Comorbidities |
Sleep Apnea |
| Policy |
Must be medically necessary |
| Comments |
I got a call from my doctor's office today "Great News" I was approved within 2 1/2 weeks...WOW I am so ready. |
| Source |
Brenda D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/14/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
48.2 |
| MD-supervised programs |
3 (252 weeks) |
| Source |
Jo-Ann T |
| Insurer Policy |
Aetna (Group) |
| Insurer Status | Approved after first letter (07/17/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
51.2 |
| Comorbidities |
High blood pressure, Boader line suger |
| Policy |
Must be medically necessary |
| Comments |
Biggest problems was follow up and making sure the hospital submitted the bills to Aetna US Health care. And than that the submitted the correct forms. Had to go back and forth with calling both to make sure correct forms were submitted. The biggest thing is to watch the bills and question everything and get your refferals and follow up, follow up , follow up, follow up. |
| Source |
Mary-Alice P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/2/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
48.7 |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
Did not deal with them directly. BTC handled everything. Notified by mail after a couple of weeks that it was approved. Although it it out of Network. |
| Source |
Maurice N |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (10/15/02) |
| Surgery Type |
RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
42.0 |
| Policy |
Must be medically necessary |
| Comments |
Dealing with Aetna was a breeze. They didn't stall with anything. They wanted certain tests and paperwork and that was all for them to make their decision. |
| Source |
Michelle O |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (10/24/02) |
| Surgery Type |
Laparoscopic Other |
| Weeks to approval |
4 |
| Pre-Op BMI |
50.2 |
| Comorbidities |
Sleep Apnea |
| Policy |
Must be medically necessary |
| Comments |
I had no problem with approval for surgery. Once I went to the surgeon for my consult visit and they wrote the letter, everything moved quickly. I got my approval within a month and was scheduled for surgery shortly thereafter. I was actually a lot easier than I expected. Aetna was wonderful. |
| Source |
Jacki H |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (4/28/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
58.5 |
| Policy |
Must be medically necessary |
| Comments |
First of all, I want to give a special thanks to the staff at the surgeons office. They were on top of everything and in one day I was approved for the surgery. How great is that. I guess my only suggestion would be to make sure that not only the surgeons office has everything together, you need to also be able to have it all together. You need to be able to have all phone numbers in one place and have your information (ie: insurance card, dates of appointments, medical history, etc.)with you in case the doctors office calls and says that they need something right now. It will only make your life easier in the long run. |
| Source |
Jennifer C |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | (11/15/02) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
5 (336 weeks) |
| Source |
Brenda D |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (01/24/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
55.7 |
| MD-supervised programs |
3 (6 weeks) |
| Comorbidities |
Depressed, Back Injury, Headaches, Tested for sleep apnea waiting results |
| Policy |
Must be medically necessary |
| Comments |
Dr. Wynn's office is taking care of everything for me. I am not sure of whether I have been approved yet or not but I do have an surgery date of Mar 3, 2003 |
| Source |
Vonya E |
| Insurer Policy |
Aetna (Jeff Plus) |
| Insurer Status | Approved after first letter (7/28/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
55.4 |
| MD-supervised programs |
2 (20 weeks) |
| Comorbidities |
back pain, reflux, arthritis, joint pain, sudden wetness |
| Policy |
Must be medically necessary |
| Comments |
The only thing they've asked for is the last 2 years of my medical chart showing Dr. supervised diet/excercise, and a letter of medical necessity. After they received the information, it only took them 3 days to approve the surgery. Have your surgeon send this information to them from the first time of contact. |
| Source |
Leigh A |
| Insurer Policy |
Aetna (Jeff Plus) |
| Insurer Status | (09/06/03) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
44.4 |
| MD-supervised programs |
3 (84 weeks) |
| Source |
Christopher A |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/13/03) |
| Surgery Type |
Open RNY |
| Policy |
Don't know |
| Source |
Isaiah Louis M |
| Insurer Policy |
Aetna (Patriot) |
| Insurer Status | Approved after appeal letter (1/15/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
61.3 |
| Comorbidities |
sleep apnea, hypertension, high cholesterol, arthritis. |
| Policy |
Don't know |
| Comments |
Atena paid for the Cardiologist, Pulmonary and the PMRI Dr's. However they did not pay for the nutrionist and Phychiatrist at PMRI.
An expense of $ 309.00 so far. Not in network was the reason even though they are a part of the Christiana Medical Care. My surgery is scheduled for 1/26/2004.
I am told to apply for surgery coverage within 45 days of my surgery date or you can be refused. Dr's office applied mid- December. I got a letter from Aetna wanting my Primary Dr's notes for the past 2 years of my medical history stating weight problems and actions we discussed. I dropped it off 12/30/2004. He didn't get it submitted until 1/8/2004 and it was approved 1/15/2004. Done. I am ready. |
| Source |
Elissa H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/22/04) |
| Surgery Type |
Laparoscopic RNY - proximal |
| MD-supervised programs |
1 (18 weeks) |
| Source |
Tracey B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/22/04) |
| MD-supervised programs |
2 (38 weeks) |
| Source |
Paula G |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (04/05/04) |
| Source |
Vonie E |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (11/17/2004) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
51.0 |
| MD-supervised programs |
4 0 |
| Comorbidities |
sleep apnea, arthritis and hypertension |
| Policy |
Don't know |
| Comments |
When I decided on having this surgery, I contacted Aetna and requested a copy of their written policy concerning obesity surgery. I had all of my paperwork in good order. The process went smoothly. |
| Source |
Rose K |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (05/12/04) |
| Source |
Elizabeth B |
| Insurer Policy |
Aetna (PCP) |
| Insurer Status | Approved after first letter (08/06/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
52.3 |
| Comorbidities |
Arthritis |
| Policy |
Must be medically necessary |
| Comments |
I did not have any problems dealing Aetna |
| Source |
Mother L |
| Insurer Policy |
Aetna (Dwight Siers) |
| Insurer Status | Approved after first letter (11/8/04) |
| Weeks to approval |
2 |
| MD-supervised programs |
1 (30 weeks) |
| Comorbidities |
Diabetes, Hypertension, High Cholesterol |
| Policy |
Must be medically necessary |
| Comments |
The insurance company was completely handled by the Barix Clinic. I would recommend letting the Doctor's insurance pros handle it. They know the ins and outs |
| Source |
Dwight S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/29/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
42.8 |
| Source |
Alfred C |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | First letter sent - still waiting (12/30/04) |
| Source |
James R |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (12/31/04) |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Source |
Mary K |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/09/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
39.3 |
| Comorbidities |
Sleep apnea, diabetes, high cholesterol, high blood pressure |
| Policy |
Must be medically necessary |
| Comments |
Like all insurance companies you have to know how to ask the questions if you want an answer that is meaningful |
| Source |
D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/30/05) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Sleep Apnea 9 years, Fibromyalgia, GERD |
| Policy |
Must be medically necessary |
| Comments |
Aetna has policy bulletins posted on their website which describe all of the requirements. Their policy requires either a 6 month diet history which must be doctor supervised and in the medical record or 3 month pre-surgical regimen including behavior modification, exercise therapy and doctor supervision. Both requirements are very detailed. Use the search feature to locate using "Gastric Bypass” It is difficult to find. I was told that your employer must purchase a rider for you to have coverage. Dr. Wynn's administrator Misty was wonderful and handled all of the details. Aetna approved me in 1 day. |
| Source |
Penelope . |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/25/05) |
| Comorbidities |
diabetes and High blood pressure |
| Policy |
Must be medically necessary |
| Comments |
I am honestly not 100% sure about all this. I know they have definite hoops you must jump through, but after that, they seem to be workable. However, after March 31 they pay for no more surgery. For that reason, I certainly could not recomment them. |
| Source |
Kimberly N |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/06/05) |
| Surgery Type |
Laparoscopic RNY |
| Source |
Theresa W |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (03/23/05) |
| Surgery Type |
Laparoscopic Revision |
| Weeks to approval |
1 |
| Pre-Op BMI |
48.4 |
| Comorbidities |
Sleep apnea, hypertention, high cholesterol, depression, GERD |
| Policy |
Must be medically necessary |
| Source |
Jennifer R |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Denied after first letter (04/29/05) |
| Source |
Jeanne H |
| Insurer Policy |
Aetna (Donna L Nash) |
| Insurer Status | Approved after first letter (08/24/05) |
| Source |
Donna N |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | First letter sent - still waiting (08/27/05) |
| Surgery Type |
Laparoscopic RNY - distal |
| Pre-Op BMI |
49.6 |
| Source |
Susan F |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/27/05) |
| Surgery Type |
Laparoscopic Lap Band |
| Comorbidities |
Arthritis, Diabetes, Hypercholesterolemia, Hypertension, Sleep apnea, proteinuria (kidney) |
| Policy |
Don't know |
| Source |
David P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/16/05) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
1 0 |
| Comorbidities |
GERD, Hypercholesterolemia, Hypertension, Obesity hypoventilation syndrome, Shortness of breath, Sle |
| Policy |
Don't know |
| Comments |
A week before surgery my husband called Aetna to be sure all was ok. They said, it has been approved just waiting for some paper work from St Francis Hospital. At 5:40PM The night before get a phone call from surgeons office saying Aetna denied claim due to insufficient paper work. My husband went frantic on the phone lines. Finally got a hold of St francis admitting office, she made a few phone calls & returned a call stating surgery is on & they have approval #. So yes Aetna sucks when dealing with them. |
| Source |
Lillian C |
| Insurer Policy |
Aetna (Select) |
| Insurer Status | (2/7/07) |
| Surgery Type |
Lap Band |
| Policy |
Written exclusion policy |
| Comments |
MY PREVIOUS EMPLOYER SAID THEY DO NOT COVER BARIATRIC SURGERY. NO EXCEPTIONS - NOTHING |
| Source |
Cecilia H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (Surgery 10/24/04) |
| Surgery Type |
Laparoscopic RNY |
| Policy |
Don't know |
| Source |
Diane S |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/05/08) |
| Surgery Type |
Laparoscopic Duodenal Switch |
| Comorbidities |
Shortness of breath |
| Policy |
Don't know |
| Source |
Tiffany G |
