| MedBen & TriCare Extra |
|---|
| Insurer Policy |
MedBen & TriCare Extra |
| Insurer Status | Approved after first letter (Mar 10, 08) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
2 |
| Pre-Op BMI |
43.3 |
| Comorbidities |
sleep apnea, hypertension, arthritis, diabeties, had fusion on lumbar 5 in 1981,been on disability e |
| Policy |
Must be medically necessary |
| Source |
Cathy K |
| A H & L |
|---|
| Insurer Policy |
A H & L (PPO) |
| Insurer Status | Approved after first letter (10/05/2001) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
47.6 |
| Policy |
Must be medically necessary |
| Comments |
The doctors office sent the paperwork to the insurance on 10/2/01 and I got approval on 10/05/01. I couldn't believe it. I was expecting a fight I was pleasantly surprised. I had everything that they ask for before we even sent anything in I think that helped. |
| Source |
Dawn B |
| Access Medical |
|---|
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (08/09/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
38.9 |
| Comorbidities |
sleep apnea,diabetes,high cholesteral,high tryglicerides,depression |
| Policy |
Must be medically necessary |
| Comments |
I was very pleased with them. I was so surprised that I got approval after just one day! They didn't stall at all. I feel like that if you get all your information they request and get it all documented and just be as thorough as possible they will approve it. It took me about 7 months to get all my paperwork and tests ready to submit...but once I did..it just took them a day to approve. Persistance in doing everything they require of you and not getting discouraged at the process. |
| Source |
Vickey F |
| Insurer Policy |
Access Medical (HMO) |
| Insurer Status | Approved after first letter (10/18/02) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
44.4 |
| MD-supervised programs |
1 0 |
| Source |
Barron G |
| Insurer Policy |
Access Medical (Premier Access) |
| Insurer Status | Approved after first letter (1/29/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
8 |
| Pre-Op BMI |
59.8 |
| MD-supervised programs |
1 (52 weeks) |
| Comorbidities |
Diabetes, Knee Pain, Swelling of legs |
| Policy |
Must be medically necessary |
| Comments |
The staff in the pre-approval department has been very easy to work with. I spoke with them on the phone several times. They required me to complete the psycholigical evaluation and a nutrional evaluation before approval. Once they receive all the information from the doctor they received my complete information on tuesday and I had an answer on friday. I appreciate their thorough evaluation of all the facts.
7/1/04 Kentucky Access has been one of the worst insurance companies I have ever seen about fighting you to keep from paying the bills. They tried to say my weight loss was a pre-existing condition, after they approved it before the surgery. Now they are only wanting to pay a small amount of the surgeon fees and keep giving the hospital the run around. This group is managed by Anthem. If you have Kentucky Access or Anthem be prepared. |
| Source |
Alan W |
| Insurer Policy |
Access Medical (PPO) |
| Insurer Status | Denied after first letter (01/09/2004) |
| MD-supervised programs |
3 (32 weeks) |
| Policy |
Written exclusion policy |
| Comments |
When I contacted Dr. Bolar's office about the surgery, I sent in the questionaire. I received a letter on Jan. 9, 2004 stating that there was an exclusion in my policy, and even if I were morbidly obese, they still would not pay for the surgery. I have e-mailed amy at Dr. Bolar's office about an appeal, but have not heard back from her. |
| Source |
Rhonda A |
| Insurer Policy |
Access Medical (PPO) |
| Insurer Status | Denied after first letter (12/06/04) |
| MD-supervised programs |
4 (56 weeks) |
| Comorbidities |
Diabetes, Hypertension, Sleep Apnia, Thyroidism, Lower Back pain |
| Policy |
Don't know |
| Comments |
The denial responce that I received stated that the procedure is considered investigational per Anthem Medical Policy SURG.00024. What ever that means. I know people that have this insurance and they too have been denied at first, but appealed and was approved.
In my oppinion; Anthen denies everyone at first and takes their sweet time doing it to weed out some of them. Some people settle for the first denial and let it go. Not me, I am going to fight with tooth and nail.
This procedure is the light at the end of a tunnel that has been dark for most of my life! |
| Source |
Tina I |
| accordia national |
|---|
| Insurer Policy |
accordia national |
| Insurer Status | Approved after first letter (04/02/05) |
| Source |
Rosie C |
| Insurer Policy |
Accordia National |
| Insurer Status | Approved after first letter (04/3/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
49.3 |
| Comorbidities |
Arthritis, Hypertension, Shortness of breath |
| Policy |
Must be medically necessary |
| Comments |
Initial consultation sith surgeon Monday, March 20, the first day of spring, my new beginning.
Paperwork sent to insurance Friday, March 24.
Received insurance approval, Monday, April 3.
Surgery scheduled for Tuesday, April 11.
I ever dreamed I would get approved so fast. I think the doctor's office called to hurry up the process. |
| Source |
Melissa H |
| achs |
|---|
| Insurer Policy |
achs |
| Insurer Status | First letter sent - still waiting (03/06/04) |
| MD-supervised programs |
2 (8 weeks) |
| Source |
Crystal M |
| acorda |
|---|
| Insurer Policy |
acorda |
| Insurer Status | Denied after first letter |
| Comorbidities |
Sleep apnea, GERD, Diabetes, Arthritis, Hypertension, Chronic skin conditions, Coronary artery disea |
| Source |
I M |
| Acordia |
|---|
| Insurer Policy |
Acordia (International Industries) |
| Insurer Status | Approved after first letter (06/12/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
41.8 |
| Comorbidities |
cardiac arythmia, sleep apnea, arthritis, gerd |
| Policy |
Must be medically necessary |
| Comments |
Dealing with Principal has been nothing but a headache so far. My insurance originally went into effect with them on May 29, 2000, and although they do cover WSL (or so it states in my policy), they still do not have my "information" entered into the system, nor have they provided me with any type of insurance card. My secondary insurance has paid for all of my consultations and evaluations so far, but say that there is nothing else that they will do until I finally get entered into Principal's system. Dr. Bolar's office has everything prepared, ready to go, but is also waiting for Principal to get me entered. I talked to my Human Resources director, and she has assured me that she has also been in touch with Principal and explained my situation to them. They told her that they would do a manual insert immediately, but that was a week ago. This is driving me crazy.
I got final approval with no problem, but the insurance company dragged its heels just a little bit and we ended up having to postpone for 1 week, other than these few little things, my experience with them wasn't really bad, just nerve racking!
|
| Source |
Rhonda T |
| Insurer Policy |
Acordia |
| Insurer Status | Approved after first letter (01/18/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
6 |
| Pre-Op BMI |
45.2 |
| MD-supervised programs |
2 (68 weeks) |
| Comorbidities |
they request your BMI, diet history,and co-morbidities |
| Policy |
Must be medically necessary |
| Comments |
Be prepared to speak to one person after another! Finally I was allowed to speak to the supervisor and he stated that he would hand deliver the paperwork to the nurses himself. After that things started to move! Still had to be approved by their physian whom requested more information from Dr, Holwick which I had to call and request. After many frustrating phone calls, and many answers of "you will have to call back tomorrow"!! There IS A GOD!!! and he knew that I was at the end of my rope, and today I was finally approved!After 6 weeks of waiting!! |
| Source |
Benita B |
| Insurer Policy |
Acordia |
| Insurer Status | Approved after 2nd appeal letter (08/03/04) |
| Comorbidities |
HTN |
| Comments |
This company is good when they finally stop stalling you. It took my friend one year to get approved and I have been waiting since May 2004 and was finally approved and had my surgery done on 2-1-05, |
| Source |
Paula B |
| Advanced Insurance Administration |
|---|
| Insurer Policy |
Advanced Insurance Administration (Harrod Community Health Plan) |
| Insurer Status | Approved after first letter (01/31/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
58.2 |
| MD-supervised programs |
5 (180 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I actually was approved in one day by the insurance company. However, it took three weeks for Dr. Shina's office to work out details with my insurance company. |
| Source |
Sandy M |
| Advantage |
|---|
| Insurer Policy |
Advantage (HMO) |
| Insurer Status | Approved after appeal letter (07/07/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
28 |
| Pre-Op BMI |
50.8 |
| Comorbidities |
GERD, Joint pain, incontinence, swelling of ankles and feet |
| Policy |
Must be medically necessary |
| Comments |
I have not been very happy with Advantage Care. I have fought and been very persistent in getting approval for this surgery.
I feel they will do everything possible to keep you from this surgery unless they know you will not give up!
BE EDUCATED, INFORMED, DOCUMENT EVERYTHING AND ABOVE ALL DO NOT GIVE UP |
| Source |
Sharon W |
| Insurer Policy |
Advantage (POS) |
| Insurer Status | First letter sent - still waiting (07/28/00) |
| Source |
Barbara W |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after first letter (10/14/00) |
| Surgery Type |
Open RNY |
| Source |
Darlene B |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/29/99) |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
none--BMI 51 |
| Comments |
I really didn't have to deal with them too much. My paperwork was submitted on Nov.15th and I was approved on Nov.17th. Unfortunately there was some difficulty in communication between them and my surgeon's office. One phone call that took less than 5 minutes was all that it took to resolve that problem. I would recommend them to anybody searching for an insurance provider. |
| Source |
Lisa F |
| Insurer Policy |
Aetna (us healthcare) |
| Insurer Status | Approved after first letter (04-99) |
| Surgery Type |
Open VBG |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.3 |
| Comments |
I had no problems with this company...in fact I never dealt with them at all...Dr. Shina"s office staff took care of everything...Also the surgery was delayed a month and I has pre-approved with no problems |
| Source |
Debbie P |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (3/16/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
65.2 |
| MD-supervised programs |
1 (6 weeks) |
| Comorbidities |
BMI 61.0; Depression, Sleep Apnea; SOB; Constant swelling and pain in both ankles |
| Policy |
Must be medically necessary |
| Comments |
I can only hope and pray that Aetna is more compassionate than Anthem. I should know one way or another within 3 weeks. Dr. Bolar warns me that they are masters at stalling. I've waited this long; I hope a few more weeks doesn't kill me. :) Finally, APPROVAL!
After submitting documentation of a medically supervised diet (which they require), they approved me within three days. I am pleased to say that everyone I talked to at Aetna was always super nice and as helpful as possible---a far cry from my experiences with United Healthcare and Anthem. Special thanks to Marilyn, the nurse who reviewed my case and got me approved! |
| Source |
Gina V |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (09/21/00) |
| Surgery Type |
Open Duodenal Switch |
| MD-supervised programs |
2 (96 weeks) |
| Policy |
Must be medically necessary |
| Source |
Jennie M |
| Insurer Policy |
Aetna (pos) |
| Insurer Status | Approved after first letter (11/06/00) |
| Surgery Type |
RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
47.6 |
| MD-supervised programs |
4 (152 weeks) |
| Comorbidities |
arthritis, swelling, depression, history of heart disease, loss of energy, shortness of breath. |
| Policy |
Must be medically necessary |
| Comments |
'Aetna did not stall at all. Once all papers were submitted there was an immediate approval. Right Weigh and Dr.Bolar's office took care of everything. Aetna representatives have been so helpful. They even called to let me know there was extended coverage including bandages, tate, etc. Another representative called to give me information about asthma and offer additional services to me. Can you believe it? I didn't even have to ask.
The representative told me they are one of the few companies who give approvals for wls over the phone! |
| Source |
Martha H |
| Insurer Policy |
Aetna (Managed Choice POS) |
| Insurer Status | Approved after first letter (02/15/2001) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
47.9 |
| MD-supervised programs |
2 (82 weeks) |
| Comorbidities |
Hypertension, Arthritis, High Cholesterol, GERD |
| Policy |
Must be medically necessary |
| Comments |
12/04/00
Had appointment with PCP today and she has given me my referral (WOOHOO!).
12/05/00
PCP's office calls telling me that Aetna won't pay for WLS...WHOA - no,no,no,no...not what Aetna told me! Not so much as hang up and call Aetna. CSR tells me that nope, they don't pay for WLS or weight loss medications. BULL S@*T!! Let me talk to someone in that place who doesn't make minimum wage. Talk to someone higher up - she'll check into it and call me back. OK......
12/06/00
Aetna calls and everything is OK. They will pay for WLS if it is "medically necessary". Alrighty then!
01/03/01
Met with my surgeon, Dr. Gaar, and his secretary will send out the letter of medical necessity in about 1-2 weeks. I will keep on top of things! :)
01/16/01
Called Dr. Gaar's secretary to see if letter had been sent out (it's been 2 weeks!)....it was going out in the mail today. I'm going to be pulling on Aetna's reins come Monday. Please Aetna!!!!!!
15 Feb 01
I'M APPROVED TODAY!!! What can I say about Aetna. First of all it took them a total of two weeks to review my case (seemed like two months though). #1 - MUST have documented physican weight loss attempt. #2 - Be a pest. Make yourself known!!! #3 - Document everything!! #4 - As hard as it might be, try to be nice...but be firm. All in all, I had a good experience with Aetna. Not to say that I wasn't sweatin' it!!!! I would HIGHLY recommend Aetna - They seem to be very understanding. I LOVE YOU AETNA and I love Steve the CSR at Aetna too - HAHAHHAHAHAHAHA. As much flack as I've given him, I guess it's only fair that I share the lovin!!! |
| Source |
Tracy C |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after appeal letter (5/30/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
12 |
| MD-supervised programs |
2 0 |
| Comorbidities |
GERD, Depression |
| Policy |
Must be medically necessary |
| Comments |
are no problem to work with. Just make sure you understand what they require for approval and provide them with all of the information they need. My information was incomplete at first submission resulting in denial of coverage.
Policy States:
Aetna U.S. Healthcare® covers the surgical treatment of obesity when the following criteria are met:
(These criteria were adapted from the NIH Consensus Conference on Surgical Treatment of Morbid Obesity.)
Presence of morbid obesity, defined as a body mass index (BMI)* exceeding 40 or greater than 35 in conjunction with severe co - morbidities such as cardiopulmonary complications or severe diabetes;
AND
documented history of repeated failure of physician - supervised medical/dietary therapies.
|
| Source |
Tammie H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/01/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
4 |
| Pre-Op BMI |
55.6 |
| MD-supervised programs |
3 (48 weeks) |
| Comorbidities |
Degenerating disks in L5 lumbar, asthma, hypertension, depression |
| Policy |
Must be medically necessary |
| Comments |
I wished my wait wasn't so long, but in the end they came through for me. They initially lost part of my medical record and after a faxing frnzy it took another week to get the information to the proper director. I find with Aetna they a pro WLS, but it pays off to be a squeaky wheel. They get irratated by daily phone calls, but remember they work for you and it is your right to know where you stand in the mountain of numbers.
It is also very helpful to right down the name of every rep. you talk to because they some times give conflicting information, alot of times it is just to get you off the phone.
I will say the the persistence pays off and over all they are very highly rated for approvals. |
| Source |
Debra N |
| Insurer Policy |
Aetna (Managed Care) |
| Insurer Status | Approved after first letter (3/12/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
50.6 |
| Comorbidities |
Sleep Apnea, hipertension, Ankle Swelling, Reflux, Joint Pain |
| Policy |
Must be medically necessary |
| Comments |
Aetna "lost" the first request. We are working on getting additional documentation before submitting second request.
Second Request was faxed to proper person. Approval received in one week. Key was having participated in doctor approved weight loss plan. (Didn't have to be doctor's plan, in my case was Diet Center,
Weight Watchers and Overeaters anonymous on several different occassions. |
| Source |
John S |
| Insurer Policy |
Aetna (MC) |
| Insurer Status | Approved after first letter (04/03/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
2 (98 weeks) |
| Comorbidities |
sleep apnea, 2 bulging disc, joint pain |
| Comments |
I really had no problems with Aetna. My problem was with the doctors office getting all the information to them. As soon as I got all the information to them, (i done all the gathering and faxing)i was approved in 2 days. So do all the gathering of information and faxing on your own. Remember you are the important one to you and the doctors office has 100's to deal with. I called them about every other day just to make sure they got the fax and if they needed more information or not. Be persistend with them. |
| Source |
Patti S |
| Insurer Policy |
Aetna (U S Helthcare) |
| Insurer Status | Approved after first letter (04/19/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1d |
| Pre-Op BMI |
42.2 |
| Comorbidities |
Arthritis |
| Policy |
Must be medically necessary |
| Comments |
so far so good keep track of whom you talk to. |
| Source |
Bill K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/09/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
42.1 |
| Comorbidities |
mild hypertension, joint pain |
| Policy |
Must be medically necessary |
| Comments |
For some reason, I had no trouble with Aetna in getting permission for my surgery. I think alot of it had to do with the mountains of paperwork I had to fill out in order to be considered. I think you need to have all your ducks in a row with Aetna. |
| Source |
Rene` R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/30/01) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
50.6 |
| MD-supervised programs |
1 (1 weeks) |
| Source |
Joyce J |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (04/28/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
53.2 |
| Comorbidities |
GERD, depression |
| Policy |
Must be medically necessary |
| Comments |
I haven't had really any trouble with Aetna, although I don't know if it is because they are so great or because my surgeon's office was so great. I'm really not sure, but I was surprised and happy to hear that they preapproved right over the phone on the day of my first consultation with Dr. Bolar. I can't guarantee that they will always be this great, but things sure worked out well, and quickly for me! |
| Source |
Alyssa B |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (06/16/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
47.9 |
| MD-supervised programs |
1 (32 weeks) |
| Source |
Marnie B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (07/10/01) |
| Source |
Sandy R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/03/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
51.3 |
| Comorbidities |
arthritus, herniated disk in my back, swelling in my feet. |
| Policy |
Must be medically necessary |
| Comments |
When my paperwork was mailed to them after 3 weeks i called. They never received it. Susan faxed it to them and I was denied. They wanted a letter from my Primary Care Physician stating I had been under supervised diet care. once i got that faxed to them I was approved in less than a week. I have not had any problems with Aetna in fact everyone I talked to were so great. I would recommend Aetna insurance 100 percent |
| Source |
Robin A |
| Insurer Policy |
Aetna (KPPA) |
| Insurer Status | Denied after 2nd appeal letter |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
hypertension, high cholesterol, acid reflux, lower back pain |
| Policy |
Written exclusion policy |
| Comments |
Humana was absolutely awful!! Their customer service reps flat out lied to me. They kept telling me conflicting information and were very rude. To sum it up......HUMANA SUCKS!!!! |
| Source |
Stacie F |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/19/01) |
| Source |
Diane W |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (01-31-02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
45.3 |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
Congestive heart failure, sleep apnea, edema of feet/legs, chronic back pain, bad knees. |
| Policy |
Must be medically necessary |
| Comments |
I have been referred to a surgeon who will perform the surgery to the criteria set by Aetna. They will only approve procedures involving a bypass. Consultation date not set yet. |
| Source |
Sandi H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (10/12/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
48.3 |
| Comorbidities |
sleep apnea, GERD, shortness of breath, some arthritis |
| Policy |
Don't know |
| Source |
Jennifer H |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | First letter sent - still waiting (10/23/01) |
| Source |
Sandy S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/18/02) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
3 (72 weeks) |
| Comorbidities |
diabetes |
| Policy |
Must be medically necessary |
| Comments |
The Dr.'s office mailed the first request on Jan. 25th. On Feb 12th it was still not recieved (I called everyday). I spoke with someone that told me to have the Dr's office call them and fax the info over. After the Dr. faxed the request, it was approved in 2 days. I didn't have but 1 failed attempt at weight loss recorded and yet no questions were asked. I would definitely recommend Aetna, but you really have to stay on top of them. |
| Source |
Tammy D |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (11/05/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
8 |
| Pre-Op BMI |
64.0 |
| Comorbidities |
Hypertension, Arthritis, Diabeties, Sleep apnea, acid reflux |
| Policy |
Must be medically necessary |
| Comments |
Actually, Dr. Shinas office staff delt with AETNA. All I had to do was provide the many pounds of paperwork and pray a lot.You must be very through in listing all the diets you have tried and directly to the point as to all the co-morbidities you have. Get names and dates of doctors you have seen and any dieticians to whom you have been sent.
I believe they stall somewhat, but this is a very expensive elective sugery.
It does pay to be persistent, as well as patient, but never, never give up. |
| Source |
Toni L |
| Insurer Policy |
Aetna (Medicaid) |
| Insurer Status | Approved after appeal letter (05/17/02) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
4 |
| Pre-Op BMI |
44.8 |
| MD-supervised programs |
3 (80 weeks) |
| Comorbidities |
sleep apnea, hypertension,arthritis,GERD |
| Policy |
Must be medically necessary |
| Source |
C C |
| Insurer Policy |
Aetna (feds) |
| Insurer Status | Approved after appeal letter (01/07/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
62.2 |
| Comorbidities |
Sleep apnea, arthritis, hypertension |
| Policy |
Must be medically necessary |
| Comments |
I didn't deal with Aetna. I got all the info they requested and submitted it through Dr. Shina's office.
They definatly respond to persistence. So I would reccommend,just stick with it. |
| Source |
Toni L |
| Insurer Policy |
Aetna (hmo/plus) |
| Insurer Status | Approved after first letter (01/29/02) |
| Surgery Type |
Laparoscopic Duodenal Switch |
| Pre-Op BMI |
46.8 |
| MD-supervised programs |
2 (104 weeks) |
| Source |
Lisa S |
| Insurer Policy |
Aetna (Epo) |
| Insurer Status | Approved after 2nd appeal letter (12/20/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
90 |
| Pre-Op BMI |
60.5 |
| MD-supervised programs |
3 (12 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Aetna is a company that absolutely must have proof of working with a doctor in a supervised plan. They have caused me a lot of trouble, I have been working with them sence June 2002 and I still have not been approved and it is November 2002. |
| Source |
Karissa C |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (02/03/02) |
| MD-supervised programs |
2 (36 weeks) |
| Source |
Suzan M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open VBG |
| Weeks to approval |
4 |
| Pre-Op BMI |
46.1 |
| Comorbidities |
hypertension, chronic asthma, constant swelling/water retension, hospitalization for minor heart/ast |
| Comments |
Aetna was cooperative. They did require extensive documentation of other things tried along with success/failure rate before approving.
I think all insurance co will try to stall, but I called them every week until I was approved to make sure I was not given the run around or excuses.
Call often-be persistant. |
| Source |
Deirdre G |
| Insurer Policy |
Aetna (super value) |
| Insurer Status | Approved after appeal letter (03/08/02) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
46.9 |
| MD-supervised programs |
1 (32 weeks) |
| Source |
Kadean B |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | First letter sent - still waiting (04/10/02) |
| Comorbidities |
arthritis, fibromyalgia, depression, degenerative disc disease |
| Policy |
Must be medically necessary |
| Comments |
I haven't even been able to get to the approval stage with Aetna yet! The surgeon I was going to see in Georgetown dropped Aetna in February (I started the process in March!). My PCP and Dr. Bolar's office tell me that Aetna doesn't reimburse well, and that a lot of people are dropping them. In fact, my PCP said he expects them to pull out of Northern Ky this year. So look for changes coming with Aetna. |
| Source |
Liz W |
