| Access Medical |
|---|
| Insurer Policy |
Access Medical |
| Insurer Status | (07/21/05) |
| Surgery Type |
Laparoscopic Lap Band |
| MD-supervised programs |
2 0 |
| Comorbidities |
PCOS |
| Policy |
Written exclusion policy |
| Comments |
07/21/05
BCBS of Louisiana has a written exclusion in their policy. Because of this, my husband and I decided to obtain a loan and go the self-pay route. |
| Source |
Tricia K |
| Acordia |
|---|
| Insurer Policy |
Acordia |
| Insurer Status | Denied after first letter (08/04/04) |
| Policy |
Written exclusion policy |
| Comments |
i've only tried once but they have a written exclusion so i was denied. there are a couple of other ladies with this insurance that also cannot get approved and they have worked harder at getting approved than me and cannot. |
| Source |
Dorothy R |
| ADVANCE RX - STATE GROUP BENEFITS |
|---|
| Insurer Policy |
ADVANCE RX - STATE GROUP BENEFITS (EPO) |
| Insurer Status | First letter sent - still waiting (01/08/03) |
| MD-supervised programs |
2 (28 weeks) |
| Source |
Angela S |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved |
| Surgery Type |
Open VBG |
| Pre-Op BMI |
56.0 |
| Comorbidities |
Diabetes, Slipped Disc in Lower Back, Mild Sleep Apnea, Arthritis, Mild Hypertensive, and GERD. |
| Source |
Virginia S |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after 2nd appeal letter (04/13/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
16 |
| Comorbidities |
Sleep apnea, hypertension, GERD, |
| Policy |
Must be medically necessary |
| Comments |
Dealing with AETNA was like talking to a blind and deaf person. Aetna's coverage policy bulletins list 2 requirements for a federal employee to be approved for the surgery - BMI of 40 or 35 with co-morbidities and history of failed physician weight loss attempts. This can be found on their website which is: http://www.aetnaushc.com/cpb/cpb_alpha.html#MAetna denied me because I only had 1 physician assisted weight loss attempt. In effect, what they were doing is relying on my past history to deny my request. They were not considering the present - co-morbidities that are negatively impacting my life and health. I researched their website and wrote a 4-page letter then faxed it to Dr. O'Connell's office with the request that my letter be included with the appeal. That was done and the appeal letter went out yesterday, 6 April 2000. Now, we wait.
Well, I finally got approved today - 13 April 2000. I have a tentative approval date next week; however, that date will be pushed back 2 weeks because of other priorities. I will publish the date when confirmed on Monday.
Surgery date is July 20th and I am so excited. That day cannot get here fast enough for me. |
| Source |
Sylvia R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/22/99) |
| Source |
Darlene H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Denied after appeal letter (09/23/99) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
46.5 |
| Policy |
Written exclusion policy |
| Source |
Rhonda D |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | (10/29/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
49.2 |
| Comorbidities |
SLEEP APNEA,, ASTHMA,, HBP, DJD |
| Policy |
Written exclusion policy |
| Comments |
The insurance company was pure hell it was a year-long battle. They denied the surgery . So I'm now a cash patient. |
| Source |
Felicia W |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (12/04/99) |
| Source |
Linda F |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/29/00) |
| Source |
April S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/99) |
| Surgery Type |
Open VBG |
| Weeks to approval |
1 |
| Pre-Op BMI |
54.6 |
| Comorbidities |
Diabetes, slipped disc in back, poly cystic ovairan disease, arthritis |
| Comments |
Aetna approved me with 48 hours. |
| Source |
Virginia S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after 2nd appeal letter (06/04/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
64 |
| Pre-Op BMI |
39.6 |
| Comorbidities |
sleep apnea, family medical history is horrible |
| Policy |
Must be medically necessary |
| Comments |
You MUST be persistant and remember to get the name of the people you speak with. I called almost every week for the last few months. Every week they said they had no record, until I gave them names of people I spoke with. Then my records miraculously appeared. I kept all paperwork and phone records. That was very important.
They stall and stall and stall, so stay on them!
DON'T GIVE UP! It took me 16 months! |
| Source |
Loretta C |
| Insurer Policy |
Aetna (Home Depot) |
| Insurer Status | Approved after first letter (10/11/01) |
| Surgery Type |
Open RNY |
| Comorbidities |
Sleep apnea, GERD, edema |
| Comments |
I had no problems with Aetna. I was approved 48 hours after my letter was faxed. They were willing to answer questions and were very positive about wls. |
| Source |
Kathy D |
| Insurer Policy |
Aetna (PPO,POS,EPO) |
| Insurer Status | Approved after first letter (12/12/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
43.6 |
| MD-supervised programs |
3 0 |
| Comorbidities |
Sleep apnea, arthritis, GERD, and Graves Disease |
| Comments |
I had absolutely no problems with this insurance company. The first approval was approved for the Dr. and the hospital, as out-of-network. The Dr's office gave me the phone number to call, and I spoke to the lady and explained there wasn't any specialist in my network. She said she would do some investigation and call me back. She called about 2 hours later and told me they would approve both in network. This is a new insurance plan my husband acquired at contract time. We pay $5 copay to the PPO, and $3 prescription. This is the first time in 26 years we have a wonderful insurance provider. |
| Source |
Deannie S |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (08/23/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
52.4 |
| Comorbidities |
Inconstince, back and neck pain, sleep apnea, Knee pain and swelling. |
| Policy |
Must be medically necessary |
| Comments |
I never had to deal with Aetna. I did call last Thursday (today is Saturday) and they said I wasn't in the system yet. So I decided to wait awhile before bugging them. I went to my mail box today and behold a letter from them. I thought it must be a denial if they sent the responce to my home. I was wrong. It was my approval letter! And just imagine they CC to my PCP, Surgeon and Hospital, instead of cc to me. I am still in shock!!!! Wonderful company. It only took 3 weeks. |
| Source |
Maria M |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after appeal letter (03/29/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
12 |
| Pre-Op BMI |
43.0 |
| Comorbidities |
GERD, joint pain, low back pain |
| Policy |
Must be medically necessary |
| Comments |
After my first request for surgery was denied, I asked my PCP to write the appeal letter. I ended up writing the letter, which he gladly signed. He has been my PCP for the past 15 years and knew my history well. I really think that this letter coming from my PCP had a lot to do with my getting approved. |
| Source |
Susan M |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Denied after 2nd appeal letter (08/23/00) |
| Pre-Op BMI |
42.3 |
| Comorbidities |
Multiple Sclerosis, Bad back, family history of high blood pressure&diabetes |
| Policy |
Must be medically necessary |
| Comments |
Aetna, I'm sure would probaly approve this as medically necessary, but because my husbands company is self insured, they wouldn't approve it no matter what information we gave them. We gave them a whole folder of information on obesity, the co-obesity, MS and obesity, notes from 2 doctors and they still wouldn't approve. They SUCK! My advice to anyone from entergy contemplating the surgery better be ready to go into debt heavy. |
| Source |
Kimberly M |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (04/02/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
45.8 |
| Comorbidities |
Diabetis, hypertension, thyroid, acid reflux |
| Policy |
Must be medically necessary |
| Comments |
I guess no one will believe my comments, but I was approved by Aetna on the first try. I had no problems getting my approval.
Today, April 2, 2001, I registered at the hospital and I didn't have to come up with any out of pocket funds. |
| Source |
Valerie L |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after appeal letter (11/29/00) |
| Source |
Patricia B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/04/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
46.4 |
| Policy |
Must be medically necessary |
| Comments |
I did not have to deal with them at all. The doctor's office did it all. I was approved in just 1 week! |
| Source |
Candace M |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Denied after first letter (06/07/01) |
| MD-supervised programs |
1 (12 weeks) |
| Source |
John S |
| Insurer Policy |
Aetna (FEDS) |
| Insurer Status | Approved after first letter (Sept 10 2001) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Comorbidities |
esophagel reflux, poor cardiovascular fitness,hypertension,osteoarthritis, dyspnea on exertion, depe |
| Policy |
Must be medically necessary |
| Comments |
WEll I have delt with Aetna for a montha and the first 3times I would call All I got was that my account was pending. It was not till the 4th week that I called and Amy told me that it would automatically take 30days for approval. That was on the 10sep when I called
On Sept 15 I was approved and the called on the 17Sep Monday and 3days later I recived my letter in the mail that I was approved.
They sent me a letter first w/copies to the hospital and doctors office that was great
They did stall too long in my book but I got approved so not worried any more. Yes I would recommend but make sure that you have Doctor Supervison on weight lost first or may get denied |
| Source |
Barbara L |
| Insurer Policy |
Aetna (Dr. Pierce) |
| Insurer Status | Approved after 2nd appeal letter (2/13/00) |
| Surgery Type |
RNY - distal |
| Weeks to approval |
20 |
| Pre-Op BMI |
48.8 |
| Comorbidities |
Plantar faciitis, corticosteroid injections with really didn't last long for the pain,severe back pa |
| Policy |
Must be medically necessary |
| Comments |
Dealing with my insurance company was very disappointing at first because they denied me at first. I continued going to the doctor for foot and back pain. I was so depressed. I even went to the doctor for diet aids that didn't work for me. After calling my insurance company several times i finally found someone who was willing to listen to me. Then I wrote the second letter and within the second or third week I got a letter approving me for the surgery. I do believe that through persistence they responded. My insurance is a good insurance company. I believe that they just wanted to make sure that I had tried everything else to lose the weight and wasn't just looking for a easy way around my weight problem. I know that within my heart they helped save my life. |
| Source |
Iris W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/19/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Policy |
Must be medically necessary |
| Comments |
They were very quick in responding |
| Source |
Christopher S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/08/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
6 |
| MD-supervised programs |
1 (16 weeks) |
| Comorbidities |
Sleep apnea, hypertension |
| Policy |
Must be medically necessary |
| Comments |
No problem at all. |
| Source |
Donald T |
| Insurer Policy |
Aetna (Managed Choice) |
| Insurer Status | Approved after first letter (07/17/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
10 |
| Pre-Op BMI |
47.4 |
| Comorbidities |
Joint problems (knee reconstruction), sleep apnea, reflux, high blood pressure, high cholesterol, st |
| Policy |
Must be medically necessary |
| Comments |
I let the surgeon's office deal with them completely (I wasn't in a big rush due to summer plans). The doctor's office indicated they sent the first letter on 5/3/01; in mid-june I called to find out the status, and the doctor's office contacted them and they indicated they had not received the letter so to fax it. I got another call from the doctor's office in mid-July indicating that I needed a letter from my PCP describing medically supervised weight loss attempts. Once I faxed this to them and they forwarded it to Aetna, I was approved. Aetna called to let me know not to worry--that they had sent a denial letter while waiting for the PCP letter, which would be followed up by the approval that was given once the PCP's letter was received. I was surprised at the length of time (close to 3 months), but took the position that "no news is good news" and decided to let it ride out through the summer or until I received a denial (whichever came first!). I don't believe it was stall tactics, and my experience with them is generally VERY responsive when I call them directly. This would have been my next step if necessary. My recommendation would be to go ahead and get the PCP to write up a short note describing his treatments for you for morbid obesity, including when he began treating you and perhaps any co-morbidities or similar problems that are exacerbated by the weight. Also any information regarding diet medications and programs and exercise problems you may have. I would take this to the surgeon's office when I first met with him (to speed up the process). |
| Source |
Anita J |
| Insurer Policy |
Aetna (USHealthcare) |
| Insurer Status | Approved after first letter (08/23/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
48.0 |
| MD-supervised programs |
2 (36 weeks) |
| Comorbidities |
Knee Pain, GERD, elevated Blood Pressure |
| Policy |
Must be medically necessary |
| Comments |
I took matters into my own hands from gathering necessary paper work to calling the contact person for my review. Had to have a detailed (!) history of physician assisted weight loss attempts. This was the determining factor in my case. Be sure to have this leg work done and submit a personal letter to the company. |
| Source |
Rhonda J |
| Insurer Policy |
Aetna (Federal) |
| Insurer Status | Approved after first letter (09/05/01) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
2 (12 weeks) |
| Source |
Lola G |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (10/10/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
49.4 |
| MD-supervised programs |
1 (52 weeks) |
| Source |
Agatha T |
| Insurer Policy |
Aetna (Medicare HMO) |
| Insurer Status | Denied after first letter (July, 2000) |
| Surgery Type |
Open Other |
| Pre-Op BMI |
46.0 |
| Comorbidities |
Arthritis, hypertension, degenerative disk disease, reconstructed left knee |
| Policy |
Don't know |
| Comments |
Dealing with Aetna gave me hives. They originally told me that the procedure would be approved. I called Dr. Martin's office and arranged for my appointment in mid-July 2000. The day before my appointment, I called to make sure that the referral had gone through, etc. so that I wouldn't have any surprises. Well, surprise. No referral. I called the insurance company to see what was going on, and they explained that WLS was excluded in Louisiana. They said it was a mistake that I had been approved (verbally -- nothing in writing, unfortunately). I cried, screamed, reasoned with them -- to no avail. I dropped them and had the surgery under my Medicare policy. It took me a year to pay off all the medical bills, but I would do it again if I had to. I had open surgery, so my hospital stay was 4 days instead of overnight. My surgery lasted 4 hours instead of 45 minutes. Therefore, my bills were a little higher than most. I think Aetna Golden Medicare is awful for doing what they did to me. Since I have had the surgery, I have been able to get off disability which got me off Medicare. The whole thing was a win-win solution for me, but all this insurance b.s. almost drove me over the edge. I don't know if their decision was based on the fact that Aetna Golden Medicare was pulling out of Louisiana on the 12/31/00 (my surgery was scheduled for 09/11/00) and they didn't want to be bothered with me, or what, so I can't say whether they would respond to persistence or not. I am so fortunate that my regular Medicare policy picked up the procedure. |
| Source |
Karen L |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (12/17/01) |
| MD-supervised programs |
3 (140 weeks) |
| Source |
Terry L |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (07/18/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
40.0 |
| Comorbidities |
No serious co-morbidities. |
| Policy |
Must be medically necessary |
| Comments |
Aetna's criteria were 35 bmi plus co-morbidities and history of dieting failure, or 40 and up bmi plus history of dieting failure. I was right at the cutoff. BMI of 40 and a history of dieting failure. |
| Source |
Susan M |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (04/11/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
4 |
| Policy |
Must be medically necessary |
| Comments |
Aetna, as any other insurance has asked us to jump through hoops and of course NEVER receives faxes or letters!! I have been waiting four weeks only to have them "request additonal information". I have just faxed letters from two PCP's with physician supervised weight loss efforts. Do they really think we would go through with surgery if we had not already tried every diet known to mankind??!!
As soon as I sent additional information requested, I was approved immediately!!
Thanks Aetna.
|
| Source |
Tami A |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (04/02/02) |
| Source |
Tammie H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Denied after 2nd appeal letter (07/01/02) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
1 0 |
| Source |
Sheila B |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (11/14/02) |
| Comorbidities |
degenerative joint disease (left knee), rheumatoid arthritis, PCOS, gout, depression. |
| Policy |
Must be medically necessary |
| Comments |
Aetna has been very helpful so far. They told me that I should know something within two weeks of receiving the letter from the surgeon. I have heard that Aetna is one of the best insurance companies to deal with, and I agree (so far, lol).
12/12/02
Aetna called surgeon's office asking for 5 yr documentation of obesity (which i have) and also a 6 mo supervised diet (got that too!) i should hear from them after this info is faxed. the waiting continues!! |
| Source |
Sarah C |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (11/16/02) |
| MD-supervised programs |
2 (185 weeks) |
| Source |
Brandy S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (12/17/02) |
| MD-supervised programs |
4 (152 weeks) |
| Source |
Debra L |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/16/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
42.9 |
| Policy |
Must be medically necessary |
| Comments |
Actually, I was under the impression I would have to fight Aetna tooth and nail, but much to my surprise, it was so fast!
Although, my PCP faxed his letter to Aetna (1/7/03), before he should have, and without all info. needed by Aetna.
Once, the surgeon's office took control and faxed info (1/15/03)approval was granted (1/16/03).
I think it was a crucial factor,having all Drs notes and updates. All symtoms and dates,the more the better.
I was prepared for an appeal, but was shocked at the quickness of it all.
Of course, I am very pleased!
Hang in there, I was ready for the fight of my life.
I'm ready to regain my good health, by loosing this weight and learning a healthy lifestyle.
March 3rd can't come quick enough!
Thanks to all of you, which e-mailed their support to me. I will keep all updated.
|
| Source |
Hazel S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/04/03) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
65.8 |
| MD-supervised programs |
3 (282 weeks) |
| Comorbidities |
hypertension, sleep apnea, GERD, hiatal hernia, asthma, Arthritis in knees (require surgery), Graves |
| Policy |
Don't know |
| Comments |
Employer changed from Cigna to AETNA on April 1, 2003; Doctor sent letter for approval on March 31, 2003 and AETNA sent approval on April 2, 2003! I was amazed at the quickness in which I was granted approval for the surgery!Much better than when I had dealings with Cigna! |
| Source |
Bonnie B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (12/5/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Comorbidities |
I have no medical problems at all. |
| Policy |
Must be medically necessary |
| Comments |
I didnt deal with them at all. The doctors office handled it all. |
| Source |
Lacey F |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/11/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
13 |
| MD-supervised programs |
2 (5 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I decided to call my insurance company after 12 weeks. They told me that they never recieved my letter and that I would have to send another one. I was upset thinking that I would have to wait another four to six weeks but the lady at the insurance company gave me the fax number. I called the nurse at the doctor's office and told her and she faxed it on a friday and it was approved that next monday. So I suggest do not wait so long to call your insurance company. Call them after four weeks to make sure that they recieved the letter. |
| Source |
Kellie B |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Denied after first letter (04/07/03) |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Sheila D |
| Insurer Policy |
Aetna (Managed Choice PPO) |
| Insurer Status | Denied after 2nd appeal letter (04/14/03) |
| MD-supervised programs |
5 (96 weeks) |
| Source |
Katie W |
| Insurer Policy |
Aetna (Managed Care) |
| Insurer Status | Approved after first letter (12/10/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
6 |
| Pre-Op BMI |
41.6 |
| MD-supervised programs |
3 (42 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Aetna approved me for one surgeon, Dr. Steeb w/ Omega hosp but then I decided to switch surgeons. I did not feel the facility was for me. All I can say is everything felt wrong. When I did that I had to re-submit all of my information to Aetna from the Weight Management Center. I am now waiting to be approved again---RED TAPE!!!!
It took almost 6 months to get approval for the new surgeon but I knew he was my man. I believe him to be the best bariatric surgeon in New Orleans. I had quite a few unexpected complications but they were handeled with brilliance and speed. |
| Source |
Kiersten S |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Denied after first letter (05/28/03) |
| Policy |
Must be medically necessary |
| Comments |
they now have a 6 month waiting period where you have to be on a program supervised by a non bariatric doctor and a nutritionist. |
| Source |
Eileen H |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after 2nd appeal letter (06/09/03) |
| Policy |
Written exclusion policy |
| Comments |
having problems seekng financial help or foor someone to help. |
| Source |
Rhonda P |
| Insurer Policy |
Aetna (PAUL MILLER) |
| Insurer Status | Approved after first letter (07/08/03) |
| Source |
Belinda M |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Denied after first letter (08/21/03) |
| MD-supervised programs |
1 0 |
| Source |
Nicole F |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (12/17/03) |
| Surgery Type |
Open RNY - proximal |
| Comments |
Aetna policy is ever changing. You have to keep checking the site for NEW changes. However if you meet everything line by line you'll get approved. |
| Source |
Tee W |
