| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/09/99) |
| Weeks to approval |
8 |
| Policy |
Must be medically necessary |
| Comments |
I had my first appt. with my Surgeon on July 15, 1999. they sent the first pre-certification off on the following Monday, they seemed to loose this copy, Dr's office sent another on August 23, 1999 they couldn't locate this one, then one was faxed, finally 8 weeks later I was approved---I actually had a lawyer step in and assist with harassing them also---he helped and only cost me $25.00 well worth it! the next day after he called twice, they had the approval! :-) even after all that, they were nice reps and I spoke with have the Customer service reps there! :-) they did approve it, and as it is looking My husband and I will only end up paying 179.00 then they pay 100 percent after that! maybe it was worth the wait??? :-) |
| Source |
Jamie T |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (October 1999) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
7 |
| Pre-Op BMI |
48.0 |
| Comorbidities |
sleep apnea, arthritis |
| Policy |
Must be medically necessary |
| Comments |
Incredible easy, but Aetna is only administrator for selfinsured American Red Cross. Only critical point was that at time of approval I did not work there, being laid off three month earlier. I kept paying COBRA, and I was scared to death that, as not currently employed there, approval will be denied. I still think it was a mistake on their side, but I wont complain. |
| Source |
Michal M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/6/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
46.7 |
| Comorbidities |
dyspnea on exertion, edema in extreities, asthma, arthralgiasa of weight bearing joints, sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
8/10 It is now 2 weeks since letter has been mailed to them. I have called twice and am told they have not recieved it yet. Hubby called this time, asked for a contact name and fax number and was told he couldnt have one, reason being he needed to have a legitimate reason for asking for that kind of information. He hung up a bit confused. =o) Will contact again next week. 8/20 When I contacted insurance, they asked for more information. They want a complete diet history (since i was born!) Stating what type of diet, pills, etc. I have tried how long, at what age, and what were the results. Waiting... 9/6 Well considering how long some of us have waited and continue to wait, I guess I was approved quickly. The biggest hang up was getting my past PCP to send up my records to verify Diet History. Actually had a gal at the insurance company call my surgeons office to ask whats up. They were ready and anxious to get going on the approval! So... Sept. 18 Im headed to the otherside!! |
| Source |
P. H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/14/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
47.5 |
| MD-supervised programs |
1 (6 weeks) |
| Comorbidities |
N/A |
| Policy |
Must be medically necessary |
| Comments |
It was very easy, the doctor's office did all the work and it was approved right away. |
| Source |
Chris B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/27/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.9 |
| Policy |
Must be medically necessary |
| Comments |
Aetna was great! I was approved after only 1.5 weeks. |
| Source |
Trish F |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | (12/30/01) |
| MD-supervised programs |
3 (36 weeks) |
| Source |
Karen P |
| Insurer Policy |
Aetna (Emily K Neilson) |
| Insurer Status | Approved after first letter (01/18/2005) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
53.8 |
| Comorbidities |
GERD, High Cholesterol, joint pain |
| Policy |
Must be medically necessary |
| Comments |
So far, so good. My employer (Citigroup) has their own separate customer service center with Aetna so I deal with them specifically and they've always been cooperative and friendly. I was informed that they have 30 days to make a decision, so I'll update after all is said and done...
OK, now that this part is over, I can say that my experience dealing with this insurance company was pleasant. I was always invited to call back with questions, so they don't mind if you're persistent. I called once a week. They never gave me the run around, though, it seemed like they didn't always know where the process was at. They didn't transfer me a million places and force me to explain the nature of my call each time, either. On the 30th official day, I called and asked for an update and the woman I spoke with said, "Oh, I need to send this to our Pre-Certification Clinical Nurse to be reviewed". I just cringed...wondering what the heck had been done during the past 30 days. I decided I would ask for this nurse's name and title and the extension that she was at. Mary Madonna was the nurse and I left a message for her to give me a call. I was not expecting one for several days, but Mary called me back within 1 hour. We spoke for just over 10 minutes and she explained the entire process and was very informative and professional. I didn't feel like she was overly empathetic, but it didn't bother me. I just kept it professional. She asked me a few questions, which I do feel helped move things in the right direction. She indicated that they like to see clear, legible notes from a physician that show a managed weightloss attempt. My surgeon's office staff informed me of that beforehand, so I was prepared. Thanks Jennifer! Again, I think getting to talk to this nurse was a key factor in getting an approval. Making it personal makes it more difficult for them to say no. I got to tell her things that I don't think she would have otherwise known. So, here I am, just the weekend later, and I'm approved. Very pleasantly surprised.
I have also learned that there are about 4 other women in my department at work that have had the surgery during the past 2 years. Good place to go if you're looking to have Gastric Bypass. BTW, Aetna does NOT cover LAP-BAND, nor does Dr.Oakley perform them. |
| Source |
Emily I |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/18/02) |
| Surgery Type |
Laparoscopic Other |
| Weeks to approval |
8 |
| Comorbidities |
Diabatic, hypertension, spinal cord injury... |
| Policy |
Must be medically necessary |
| Comments |
Dealing with Insurance Companies is alot of hard work, they try to wear you down and see if you'll go away...I've found it pays to be persistant, but nice... |
| Source |
Kathy H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/22/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
46.6 |
| Comorbidities |
arthritis and sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
great never had to personally deal with them
plus had secondary insurance that paid balance of bills tricare prime
would highly recommend but they have had some policy changes this year so check close |
| Source |
Stephanie A |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/05/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
50.8 |
| Source |
Hali J |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Denied after first letter (06/25/2003) |
| MD-supervised programs |
2 (58 weeks) |
| Policy |
Must be medically necessary |
| Source |
Julie A |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (04/23/03) |
| MD-supervised programs |
1 (26 weeks) |
| Source |
Vic C |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after appeal letter (04/28/03) |
| Surgery Type |
Laparoscopic RNY |
| Source |
Michelle K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/30/04) |
| Weeks to approval |
2 |
| Comorbidities |
high BP, insulin resist., GERD |
| Policy |
Must be medically necessary |
| Comments |
I have friends who had many problems getting approval from AETNA, but I have no complaints. I highly suggest looking up their approval requirements for gastric bypass surgery ahead of time. Also, I obtained a copy of all of my medical records for 5 years back and took it in to my 1st doctor's visit. It took his staff no time to write the letter to my insurance requesting approval. I was given the thumbs up in 2 weeks.
I have been told that AETNA generally denies on the first request. NEVER give up. Make sure you ask them to reconsider as many times as possible. I have been told by many that persistence pays off. |
| Source |
R O |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after 2nd appeal letter (08/17/04) |
| Weeks to approval |
20 |
| Comorbidities |
Kenedy stones |
| Policy |
Must be medically necessary |
| Comments |
Yes,They were great after I got it accpted. |
| Source |
Veronica E |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/14/04) |
| Surgery Type |
Laparoscopic RNY |
| Policy |
Don't know |
| Source |
Jess B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (12/18/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
49.3 |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Richard M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/18/05) |
| Surgery Type |
Open Duodenal Switch |
| Pre-Op BMI |
37.0 |
| Source |
Teri K |
| Insurer Policy |
aetna |
| Insurer Status | Denied after first letter (04/18/05) |
| Source |
Sandy P |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | First letter sent - still waiting (07/22/07) |
| Surgery Type |
Laparoscopic Lap Band |
| Pre-Op BMI |
51.4 |
| Comorbidities |
Hypertension, Sleep Apnea, Acid Reflux and Diabetic |
| Policy |
Must be medically necessary |
| Comments |
This whole process has been silly. I started on 10/05 with my then primary Dr, then did theseminar with Dr. B.A., followed all the rules and 22 months later and 2 apeals later I have still been denied. I've gotten smart, I have changed Dr's. I actaully see my new Dr. on 7/25, Lord willing this will be the one. |
| Source |
Nancy H |
| Anthem |
|---|
| Insurer Policy |
Anthem (Century Prefered) |
| Insurer Status | Approved after first letter (12/07/05) |
| Surgery Type |
Laparoscopic RNY - proximal |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
Depression, Hypercholesterolemia |
| Policy |
Must be medically necessary |
| Comments |
The doctors office submitted my paperwork Monday evening and I was approved by Wednesday morning!! Great experience! Highly reccomend to anyone looking for insurance for WLS. |
| Source |
Heather . |
| Anthem Blue Shield |
|---|
| Insurer Policy |
Anthem Blue Shield (ppo) |
| Insurer Status | First letter sent - still waiting (01/25/06) |
| Comorbidities |
Arthritis, Chronic skin conditions, Depression, Shortness of breath, Stress incontinence |
| Source |
Johanna F |
| bc/bs |
|---|
| Insurer Policy |
bc/bs |
| Insurer Status | Approved after first letter (12/10/05) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
42.0 |
| Comorbidities |
Depression, Diabetes, GERD, Shortness of breath, Stress incontinence |
| Source |
Brandi K |
| BCBS of MA |
|---|
| Insurer Policy |
BCBS of MA |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY - distal |
| MD-supervised programs |
1 (24 weeks) |
| Source |
Michele G |
| bcbsma |
|---|
| Insurer Policy |
bcbsma (ppo) |
| Insurer Status | Approved after first letter (8/6/07) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
1 |
| Comorbidities |
sleep apnea, prediabitic, high cholesterol |
| Policy |
Don't know |
| Source |
Gwen H |
| blue cross |
|---|
| Insurer Policy |
blue cross (walmart) |
| Insurer Status | Denied after first letter (06/25/05) |
| Source |
Jenifer C |
| Insurer Policy |
Blue Cross |
| Insurer Status | (07/07/05) |
| Source |
George R |
| Insurer Policy |
Blue Cross (PPO) |
| Insurer Status | Denied after first letter (08/11/05) |
| Surgery Type |
Open Duodenal Switch |
| Policy |
Written exclusion policy |
| Comments |
They would only pay $5,000 lifetime benefit toward obesity, and only toward the RNY. I had no desire for the RNY. I would have rather stayed fat than have that surgery. Even if I could have appealed and gotten them to put that amount toward the DS, the cost still would have been prohibitive here in the states. They were not great to deal with, either. Very condescending.
So, I chose to self-pay for the DS with Dr. Marchesini in Brazil. My medical costs were $9,700 (doctor $4,000, hospital $5,000, private nurse $300, pre-op tests $300, Rx after surgery and heparin shot for plane ride home approx $100 total). Including plane tickets (Mom went with me), passports and visas (paid extra for rush service), hotel, food, souvenirs, cab fare and other costs related to sightseeing, etc., I spent total about $13,500. |
| Source |
Amanda E |
| Insurer Policy |
Blue Cross (PPO) |
| Insurer Status | Approved after first letter (10/19/05) |
| Source |
Sara W |
| Insurer Policy |
Blue Cross (PPO) |
| Insurer Status | Approved after first letter (03/29/06) |
| Surgery Type |
Laparoscopic RNY - distal |
| Comorbidities |
Chronic skin conditions, Depression, Shortness of breath |
| Source |
Angelo A |
| Insurer Policy |
Blue Cross (Fep Blue) |
| Insurer Status | Approved after first letter (04/02/06) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
44.2 |
| Comorbidities |
Depression, Hypercholesterolemia, Obesity hypoventilation syndrome, Shortness of breath |
| Source |
Belinda G |
| Insurer Policy |
Blue Cross (PPO) |
| Insurer Status | Denied after 2nd appeal letter (January 2008) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
55.4 |
| Policy |
Written exclusion policy |
| Source |
Carrie M |
| Blue Cross Blue Sheild of Minnesota |
|---|
| Insurer Policy |
Blue Cross Blue Sheild of Minnesota (PPO) |
| Insurer Status | Approved after first letter (02/23/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Diabetes, Sleep apnea |
| Source |
Jennifer J |
| Blue Cross Blue Shield |
|---|
| Insurer Policy |
Blue Cross Blue Shield (FEP) |
| Insurer Status | Denied after first letter (02/2007) |
| Comorbidities |
fibromyalgia,arthritis, mild GERD,L5-S1spondolothisis |
| Policy |
Must be medically necessary |
| Comments |
Insurance company is responsive.
Due to difficulties with a specific medical professional original documentation submitted to insurance was incorrect. Currently in the process of clairfying my medical record. Feel that my insurance will, with proper documention, approve my surgery within the next several months. |
| Source |
Teri W |
| Blue Cross Blue Shield of Illinois |
|---|
| Insurer Policy |
Blue Cross Blue Shield of Illinois (Timothy McAdams) |
| Insurer Status | Denied after first letter |
| Comorbidities |
GERD, Shortness of breath, Stress incontinence |
| Source |
Tina M |
| Blue Cross Blue Shield of Illinosis |
|---|
| Insurer Policy |
Blue Cross Blue Shield of Illinosis (CHI group C20043) |
| Insurer Status | Denied after first letter (05/23/05) |
| Source |
Vicky S |
| blue cross of ca |
|---|
| Insurer Policy |
blue cross of ca (ppo) |
| Insurer Status | Approved after first letter (04/29/05) |
| Surgery Type |
Open Duodenal Switch |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.4 |
| Comorbidities |
hyperinslumia |
| Policy |
Must be medically necessary |
| Comments |
They where very helpful. I did have one issue because they advised the ds was approved (i had previously got the rny approved) but it was just the approval for the rny still. So far haven't had any stalls. |
| Source |
Pittlo G |
| Insurer Policy |
Blue Cross of CA |
| Insurer Status | Approved after first letter (04/16/06) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
47.0 |
| Source |
Kimberly W |
| Blue Cross of Idaho |
|---|
| Insurer Policy |
Blue Cross of Idaho (PPO) |
| Insurer Status | (10/16/2006) |
| Surgery Type |
Laparoscopic Lap Band |
| Policy |
Don't know |
| Comments |
They have a exclusion for weight loss surgery so I had to do a private pay. My insurance did pick up the cost of some of the small parts of it because they were just billed as visits. |
| Source |
Jolana V |
| Insurer Policy |
Blue Cross of Idaho (PPO) |
| Insurer Status | Denied after first letter (04/24/05) |
| Source |
Kim E |
| Insurer Policy |
Blue Cross of Idaho |
| Insurer Status | Denied after first letter (03/18/06) |
| Source |
Chris F |
| Insurer Policy |
Blue Cross of Idaho |
| Insurer Status | (06/21/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Diabetes, Hypercholesterolemia |
| Policy |
Written exclusion policy |
| Comments |
Blue Cross of Idaho has a specific written exclusion and will NOT pay for bariatric surgery for any reason unless you are actually in a life-threatening situation in the ER. So basically they won't pay. I called two or three times to double and triple check, and each time they refused payment consent. I finally decided to finance the surgery myself and tell BC of ID to go eat beans! If I had a choice I would leave BC and go with someone else, but this is the insurance company my husband's employer has chosen, so I'm stuck. |
| Source |
Winnie S |
| Insurer Policy |
Blue Cross of Idaho |
| Insurer Status | Approved after first letter (July) |
| Surgery Type |
RNY |
| Weeks to approval |
2 |
| Policy |
Must be medically necessary |
| Comments |
Jennifer with Dr. Oakley's office handled everything.
Initially they needed more information, I thought it would be denied. They were claiming it as pre-exisiting conditions and required more infor from my Primary Physician.
Jennifer called me to inform me of what BC of ID was asking for. It took me two phone calls. One call to my previous insirer asking them to send a creditable coverage letter to BC of ID and the other to my Primary Physician's office to ask them to release records to my Bariatric Surgeon. I had to go sign a paper for them to release, but that was simple.
In 2 days, I got a call from my SUrgeon's office letting me know it was approved!! |
| Source |
Kristin A |
| Insurer Policy |
Blue Cross of Idaho |
| Insurer Status | Denied after first letter |
| Policy |
Written exclusion policy |
| Comments |
Blue Cross of Idaho lists obesity surgery as one of their exclusions; they consider it to be a cosmetic procedure. Because it is listed as an exclusion that is thier "out". I think their policy is outdated and needs to be re-evaluated. My surgery probably saved my life. |
| Source |
Ceo L |
| Blue Cross of MN |
|---|
| Insurer Policy |
Blue Cross of MN |
| Insurer Status | Approved after first letter (03/05/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Comorbidities |
Depression, GERD, Hypertension, Sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
No Problems |
| Source |
Rick H |
| Blue Cross of TX |
|---|
| Insurer Policy |
Blue Cross of TX (EPO) |
| Insurer Status | |
| Surgery Type |
Open RNY |
| Source |
Christine K |
| Blue Cross/Blue Shield |
|---|
| Insurer Policy |
Blue Cross/Blue Shield (Preview) |
| Insurer Status | Exclusion |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
67.8 |
| Comments |
Blue Cross of Idaho excludes any treatment for obesity, even if medically necessary. |
| Source |
Michael Q |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | |
| Surgery Type |
Lap Band |
| Source |
Jen B |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after appeal letter (January 22, 2000) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Pre-Op BMI |
46.5 |
| Comorbidities |
sleep apnea, hypertension, join pain, back pain, severe depression |
| Policy |
Must be medically necessary |
| Comments |
I knew going in to the process that this company normally does approve the surgery, so I was hopeful. I received a response about 3 weeks after my first letter. They wanted more information about my medical problems caused by the obesity, and also some psychological information. My surgeon and my therapist submitted the information, and I was notified of approval in about 3 more weeks.
They were very easy to deal with, and I did not feel like they were stalling or trying to make things difficult for me. I think they were just being thorough.
All in all, I'm very pleased with how the process went. |
| Source |
Lisa A |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | First letter sent - still waiting (12/12/99) |
| MD-supervised programs |
2 (36 weeks) |
| Source |
Stephanie A |
