| BCBS IL |
|---|
| Insurer Policy |
BCBS IL ( PPO) |
| Insurer Status | Approved after first letter (January 18, 2008) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.8 |
| MD-supervised programs |
1 (26 weeks) |
| Comorbidities |
Hypothyroidism, IBS |
| Policy |
Must be medically necessary |
| Comments |
After reading the blogs regarding BCBSIL PPO I was a bit nervous. but they were very nice and helpful . I was approved in 3 days. |
| Source |
Bravonna B |
| Medicaid, Medicare |
|---|
| Insurer Policy |
Medicaid, Medicare |
| Insurer Status | Approved after first letter |
| Comorbidities |
GERD, Diabetes, Arthritis, Hypertension |
| Source |
Jaqueline J |
| 1199 National Benefit Fund |
|---|
| Insurer Policy |
1199 National Benefit Fund (PPO) |
| Insurer Status | Approved after legal action taken (08/31/06) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
53.3 |
| MD-supervised programs |
3 (36 weeks) |
| Comorbidities |
GERD, Hypertension, Depression, Shortness of breath, Polycystic Ovarian Syndrome |
| Policy |
Must be medically necessary |
| Comments |
The worst insurance company that I have ever dealth with, not only did they deny surgery, but they didn't pay for a few of my ER visits. Empire Bluecross Blueshield has never done anything like this-deny ER visits! |
| Source |
Tha Pinkster T |
| 1st medical network |
|---|
| Insurer Policy |
1st medical network (ppo) |
| Insurer Status | Approved after first letter (03/23/05) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
50.0 |
| Source |
Karen C |
| accordia(perdue farms) |
|---|
| Insurer Policy |
accordia(perdue farms) (ppo) |
| Insurer Status | Denied after first letter (2-2006) |
| Comorbidities |
hypertension,sleep apnea,reflux,chonic foot pain,due to flat feet |
| Policy |
Written exclusion policy |
| Source |
Yolanda T |
| ACEC Plan (KVI) Private Healthcare Systems |
|---|
| Insurer Policy |
ACEC Plan (KVI) Private Healthcare Systems (ACEC Life/Health Plan) |
| Insurer Status | Approved after first letter (05/04/00) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
45.8 |
| MD-supervised programs |
1 (28 weeks) |
| Source |
Deborah L |
| Acordia |
|---|
| Insurer Policy |
Acordia (Shaw Inds- Will Not Pay) |
| Insurer Status | Denied after 2nd appeal letter (08/29/99) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
52.5 |
| Comorbidities |
Diabetes, sleep apnea, high cholesterol, and various other conditions. |
| Policy |
Written exclusion policy |
| Comments |
They are very vague and stall as long as posible before dening claims. My best advice would be to get an attorney up front. |
| Source |
Ronnie C |
| Insurer Policy |
Acordia (West Ga Health System) |
| Insurer Status | Approved after 2nd appeal letter (05/09/2004) |
| Surgery Type |
Laparoscopic RNY - distal |
| MD-supervised programs |
6 (100 weeks) |
| Policy |
Must be medically necessary |
| Source |
Lisa A |
| Insurer Policy |
Acordia (Healthstar) |
| Insurer Status | Approved after first letter (07/24/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
GERD |
| Policy |
Don't know |
| Comments |
They were great and everything seemed to go very smoothly! |
| Source |
Sandy W |
| Insurer Policy |
Acordia |
| Insurer Status | Approved after first letter (12/28/02) |
| Surgery Type |
RNY |
| Pre-Op BMI |
46.8 |
| Comorbidities |
Sleep apnea, arthritis, back pain, asthma, Gerd,/ Hypertension |
| Policy |
Don't know |
| Source |
Dee S |
| Insurer Policy |
Acordia (PPO) |
| Insurer Status | Approved after first letter (2/27/04) |
| Surgery Type |
Laparoscopic Lap Band |
| MD-supervised programs |
1 (16 weeks) |
| Comorbidities |
Hypertension,Diabetes,High Cholesterol,Deppression |
| Policy |
Must be medically necessary |
| Comments |
They are the best my consulation was on 2/19/04 and they took 5 days to write a good through letter and faxed it the insurance company got it on the 24th of feb.,and approved it on the 26th and mailed it out on the 27th,we are waiting on it to come if it does not come by Monday the 8th I am going to have the insurance company fax it. |
| Source |
Jessica F |
| Insurer Policy |
Acordia |
| Insurer Status | Approved after first letter (3/30/04) |
| Weeks to approval |
2 |
| Comorbidities |
hypertension |
| Policy |
Must be medically necessary |
| Comments |
I had no problems at all with my insurance. I was very satisfied. |
| Source |
Susan W |
| Insurer Policy |
Acordia (PPO) |
| Insurer Status | Approved after first letter (07/16/04) |
| Comorbidities |
diabetes,high blood pressure,high chlosterol,hyperplasia |
| Policy |
Must be medically necessary |
| Comments |
Easy.
No.
Yes but I did not need to they approved me in 2 days.
get this insurance they are great |
| Source |
Jessica F |
| ACS Benefits, INC |
|---|
| Insurer Policy |
ACS Benefits, INC (PPO) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
55.0 |
| MD-supervised programs |
1 (32 weeks) |
| Comorbidities |
Sleep Apnea, hypertension, degenerative disk disease |
| Policy |
Must be medically necessary |
| Comments |
I was very impressed with the time that my insurance company took on approval of my WLS. I had everything ready to send them, so there wasn't any time delay. |
| Source |
Sherry S |
| Administrative Solutions |
|---|
| Insurer Policy |
Administrative Solutions (PPO) |
| Insurer Status | Approved after first letter (06/07/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
3 |
| Comorbidities |
hypertension |
| Policy |
Written exclusion policy |
| Comments |
When I first called they said they had a exclusion for weight loss surgery, but I went to the surgeon and he sent in the letter of medical necessity and I was approved in 3 weeks. I found out they have a max amount they will pay for. $10,000.00 life time. Thats better then none at all. Wish it was more. |
| Source |
Robert S |
| Insurer Policy |
Administrative Solutions |
| Insurer Status | Approved after first letter (12/22/02) |
| Source |
Stephennie S |
| Insurer Policy |
Administrative Solutions (Health Partners Plus) |
| Insurer Status | Approved after first letter (03/02/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
46.3 |
| MD-supervised programs |
1 (28 weeks) |
| Source |
Carrie R |
| advanced data solutions |
|---|
| Insurer Policy |
advanced data solutions (med plan) |
| Insurer Status | Approved after first letter (11/11/01) |
| Surgery Type |
Laparoscopic Other |
| Weeks to approval |
9 |
| Pre-Op BMI |
65.1 |
| Comorbidities |
Joint back feet pain |
| Policy |
Must be medically necessary |
| Source |
Sherri S |
| Advica |
|---|
| Insurer Policy |
Advica |
| Insurer Status | Approved after first letter (12/22/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
39.8 |
| Comorbidities |
None |
| Comments |
I had no problem getting my surgery approved, which surprised me seeing as I have no co-morbities. I received a letter from Dr. Proctor's office on a Thursday informing me that my paperwork had been sent to Advica for approval, and got a call from his office the next day to schedule my surgery.
UPDATE: 1/4/2002 I found out today that my insurance does not cover the laprascopic surgery, as I had hoped to have. So, I'll be having an open surgery. This was the only problem I have encountered with my insurance. |
| Source |
Carmen S |
| Advica Health Resources |
|---|
| Insurer Policy |
Advica Health Resources (Health Parters Plus) |
| Insurer Status | (05/05/02) |
| Source |
Alexis A |
| Aenta |
|---|
| Insurer Policy |
Aenta (PPO) |
| Insurer Status | Approved after first letter (8/02/2007) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Policy |
Must be medically necessary |
| Source |
Almetha F |
| Aetna |
|---|
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after appeal letter (12/1998) |
| Policy |
Must be medically necessary |
| Source |
Steve G |
| Insurer Policy |
Aetna (Hmo) |
| Insurer Status | Approved after first letter (07/13/00) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
57.0 |
| MD-supervised programs |
1 (3 weeks) |
| Policy |
Must be medically necessary |
| Comments |
there are a lot of hoops to jump thru but it is very worth while
No too bad really if you are truly obese.
NO
Be patient(ha) they take forever but it is so worth the wait. |
| Source |
Penni T |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (May 2000) |
| Weeks to approval |
2 |
| Comorbidities |
Sleep Apnea, reflux, |
| Policy |
Must be medically necessary |
| Comments |
All I did was write a letter of what all I have done in my lifetime to try to lose weight. With that letter along with the letter from the surgeon, and the Pulmonologist, it took two weeks and they approved me. NO FIGHTING! |
| Source |
Debbie H |
| Insurer Policy |
Aetna (Open Choice PPO) |
| Insurer Status | Approved after first letter (1/9/2001) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
47.6 |
| Comorbidities |
Acid Reflux, Stress Incontinence, IBS, joint pain, amenhorrea, strong family history of heart diseas |
| Policy |
Must be medically necessary |
| Comments |
Aetna took nearly 2 months to even get me in their system as a covered person.
12/12/00 - My surgeon's office sent my letter in today. And now I wait!!
12/19/00 - Aetna claims that they never received my surgery request from Dr. Champion's office. surprise, surprise!
12/20/00 - Dr. Champion's office re-faxed my request.
12/21/00 - Frank E. at Aetna acknowledged receipt of the fax yesterday and confirmed that he personally carried the fax to the correct department. Frank says I should hear something in about 2 weeks. Now I will call every 2 days to check the status of my request.
1/9/01 - UPDATE!! I'm approved!!! Finally!! After 3 weeks...
1/18/01 - I've got a date! Tuesday, February 6, 2001, at Emory Dunwoody Medical Center!!!! YIPPEE!!!!
2/1/01 - GREAT NEWS!!!!! Aetna approved Dr. Champion to be paid as an in-network provider, even though he's out of network. I made that request as a shot in the dark...because there's no surgeon here in Columbus who does RNY. It worked! If you are interested in trying this with your insurance company, email me and I will send you a copy of the letter that I used to make this request.
|
| Source |
Teresa H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/28/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Comorbidities |
None |
| Policy |
Don't know |
| Source |
H.M. G |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (12/02/99) |
| MD-supervised programs |
1 (24 weeks) |
| Source |
Susanne S |
| Insurer Policy |
Aetna (Open Choice PPO) |
| Insurer Status | Approved after first letter (12/16/99) |
| Surgery Type |
Laparoscopic RNY - distal |
| Pre-Op BMI |
47.7 |
| MD-supervised programs |
3 (22 weeks) |
| Comments |
I was fortunate in that I had no insurance problems whatsoever. |
| Source |
Rhonda P |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (March, 2000) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
40.7 |
| MD-supervised programs |
3 (4 weeks) |
| Comorbidities |
GERD |
| Policy |
Must be medically necessary |
| Comments |
Was approved in 2 weeks
Have to have a BMI of 40
Must be 100 pounds overweight |
| Source |
Betty H |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (05/05/00) |
| Surgery Type |
Open RNY |
| Source |
Cyndi |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/10/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
45.2 |
| MD-supervised programs |
1 (40 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I have my fingers crossed! I am just beginning the process. However, from what I have seen others experience on this site with my insurance company... It seems to be fairly simple if medically necessary. I certainly feel it is medically necessary. Guess that is up to the docs!
I found a written policy on Aetna's web page
http://www.aetnaushc.com/cpb/data/CPBA0157.htm
03/10/00 WAHOO! I received an email from a VERY NICE lady at Aetna today stating my surgery has been approved! My doctor's office isn't open today so I will have to wait until Monday to set my surgery date!
|
| Source |
Kimberly C |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (03/01/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
57.5 |
| Comments |
i had no problems with insurance i only had to get referrals for pre op clearence for other doctors (specialest)
and they approved me in 4 weeks with only one letter
iwent into the doctors office on oct 12 an had my sergery date nov 15
so on january 30 2001 i will be at northside hospital making a life change |
| Source |
Shannon J |
| Insurer Policy |
Aetna (Managed Care) |
| Insurer Status | Approved after first letter (03/07/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
51.8 |
| Comorbidities |
None, just morbid obesity |
| Policy |
Must be medically necessary |
| Comments |
I was a very easy process...I went to the Doctor on 2/18 and on 3/3 they called and told me that I was approved for the surgery. When I had the Gastro Plasty, I had Alliance PPO and they took longer than usual. It took about 6 weeks or so in order to get approved, but I did get approved and had to pay $1000 out of pocket expenses. But with Aetna, I pay nothing because I had a referral from my Primay Care Physician, and the surgery is medically necessary.. |
| Source |
Daphne P |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (04/04/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
4 |
| Pre-Op BMI |
48.7 |
| Comorbidities |
hypothyroidism, sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
I only spoke to the insurance company once. The person I spoke to was very nice and had an answer to me in the exact time she said, which was one week from the date I spoke to her. I never got the feeling they stalled. My advice when dealing with this company is have "all your ducks in a row." When you visit the surgeon, have a letter made out to your insurance company and the doctor which states the problems you've had with weight. Be SPECIFIC, SPECIFIC, SPECIFIC. Outline feelings you've had, experiences with other people that made you feel terrible, diets you've been on, etc. The doctor will attach your letter to the application for pre-certification. I think this gives the insurance company some personal sense of the horror you've lived as an obese person. Anyway, it seemed to help me. |
| Source |
Sonya H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/26/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
55.1 |
| MD-supervised programs |
4 (46 weeks) |
| Comorbidities |
GERD, ARTHRITIS, HYPERTENSION, SEVERE DIABETIES, |
| Policy |
Must be medically necessary |
| Source |
Sherline A |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/09/01) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
62.8 |
| Source |
Nicole D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (04/28/00) |
| MD-supervised programs |
2 (24 weeks) |
| Source |
Roslynn P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (2/15/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
61.1 |
| Comorbidities |
osteo-arthritis in both knees, high bp, |
| Policy |
Must be medically necessary |
| Comments |
aetna was wonderful! I was approved in 3 days. They have paid for everything but my deductible and co-pays. |
| Source |
Terrie E |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/16/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.1 |
| MD-supervised programs |
2 (16 weeks) |
| Comorbidities |
amnorhea, acid reflux, lower back pain, knee pain, asthma |
| Policy |
Must be medically necessary |
| Comments |
I didn't really have any problems with aetna, they just took their time to get back to my dr's office. The first time I called they couldn't find any requests in the computer for any procedures and I got some misleading information from one of the customer service reps. but all in all I think that my having all the proper paperwork in order when we sent it in definately made things go a lot faster. I called the next day to make sure that they got the "packet" and they did approve it when they said they would. This company obviously is one of the easiest to get approval with. |
| Source |
Tonia |
| Insurer Policy |
Aetna (Emory Choice) |
| Insurer Status | Approved after first letter (8/28/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
41.4 |
| MD-supervised programs |
4 (334 weeks) |
| Comorbidities |
GERD, Sleep apnea, arthritis of lower extremities, herniated disc |
| Policy |
Must be medically necessary |
| Comments |
7/12/00 - I called Aetna to find out what exactly they need for approval. I spoke with the patient management department and the lady told me the only requirement was for the surgeon to call Aetna and give the info over the phone...nothing was required to be mailed or faxed in. She said they have very clearly written in black and white/policy bulletins (I have copy of) and if you meet the criteria, then it is approved.......we will see.8/24 Still waiting on insurance approval. Dr office put a tentative date of 10/3 for surgery, even though I will have surgery in September. So Aetna wasn't in any hurry.
I have been persistant this week and should know something this week......keep our fingers crossed.
I got approval today. My info was sent on 8/15 and they asked for additional info on 8/16 and it was sent. I called them everyday last week and got approval TODAY. 100% coverage.
I certainly feel my persistance paid off. They make note of every call on your case and I called everyday as the patient and as my PCP's office. I work for my PCP...so that was ok. I called to check the status. I was able to get through to some REAL people and get the scoop. I would recommend that you make sure your PCP's office stays on top of the approval and calls several times a week. I got my actual approval letter from the insurance company on 9/1 and my pcp got his on 9/5. Overall Aetna was pretty easy to deal with and everyone I spoke to on the phone was very nice. |
| Source |
Terry M |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | (03/01/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Arthritis, Chronic skin conditions, Depression, Diabetes, GERD, Hypercholesterolemia, Hypertension, |
| Source |
Sherie L |
| Insurer Policy |
Aetna (MC) |
| Insurer Status | Approved after first letter (08/18/00) |
| Surgery Type |
Open RNY - distal |
| Policy |
Must be medically necessary |
| Comments |
I had no problems what so ever with Aetna. I was approved in about three days. I called ahead to let them know that my paperwork was coming. Called back to confirm that they had recieved it. My advice to anyone who is trying to get approved for this surgery is be prepared. When I arrived at Dr. Waits' office for my first consultation, I had all my paperwork ready so that Karen was able to fax the same day. Paperwork as in: the forms from Dr. Waits's office, my personal letter to the insurance company, my co-morbidities, family history, my failed diet attempts. I also included a list of the things that I will be able to do after surgery that I couldn't do before because of my weight. I believe these things helped in my getting approved so fast. |
| Source |
Katina F |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09\7\00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
6 |
| Policy |
Must be medically necessary |
| Comments |
After the first letter was sent I had
precertification test to do such as an
upper GI, Gallbladder Ultrasound, get
clearance from my Cardiologist, and a
pulmonologist, and also from my PCP.
After this was completed it took 4 working
days. So once they knew it was medically
necessary they approved me almost immediately. THANK YOU GOD!!! |
| Source |
Yolanda E |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (1/17/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Comorbidities |
I'm pretty healthy, not major problems |
| Policy |
Must be medically necessary |
| Comments |
I wrote a personal letter and I think that helped. |
| Source |
Karen V |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (02-02-01) |
| Surgery Type |
Open RNY |
| Comorbidities |
esophageal reflux, hypertension,joint/hip/back problems,sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
this insurance has been super. it has to be medically necessary and you have to be at least 100 lbs over weight. the doctors office faxed in the medical necessity letter on monday, 2-5-01 and i called the doctors office to see if it had been mailed in, they told me i was already approved, just waiting on the formal letter. they already gave them the numbers needed to begin. i would recommend this insurance highly and really appreciate how fast they work and try to help |
| Source |
Julie W |
| Insurer Policy |
Aetna (Patriot V) |
| Insurer Status | Approved after first letter (08/24/00) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
48.6 |
| MD-supervised programs |
3 (100 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Dr's office submitted request and we had notice within 5 business days... APPROVED! WOO HOO I'm soo excited! |
| Source |
Brenda W |
| Insurer Policy |
Aetna (USAccess) |
| Insurer Status | Approved after first letter (04/16/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Comorbidities |
None |
| Policy |
Must be medically necessary |
| Comments |
Aetna has been great, however, I had to first go through Promina because my PCP is with them. What an ordeal! But they have to follow Aetna's guidelines, which was probably the only reason I was approved, since my PCP gave me a hard time even getting a referral for a consultation! |
| Source |
Kym N |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (11/27/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Policy |
Don't know |
| Source |
Shae J |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (1/11/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
43.9 |
| MD-supervised programs |
1 (6 weeks) |
| Policy |
Don't know |
| Comments |
I had no problems getting approved, not to mention the fact that I am just barely eligible for this surgery. I didn't call the doctor's office once, because I didn't want to bug them. Neither did I call my insurance company. I figured I would find out one way or another and I did! Two weeks to the day that I went for my consult, I received the approval letter in the mail. My insurance (POS) covers 80% of the surgery and hospital fees, but my annual maximum out of pocket expense is only $1,000 and I can handle that! |
| Source |
Laura P |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (12/06/00) |
| Weeks to approval |
5 |
| Comments |
my paperwork was recieved on 12/27/00
IM APPROVED!!! 01/16/2001 |
| Source |
Julie T |
