| BlueCross Blue Shield |
|---|
| Insurer Policy |
BlueCross Blue Shield (Federal) |
| Insurer Status | Approved after first letter (05/12/05) |
| Weeks to approval |
1 |
| Pre-Op BMI |
47.6 |
| Comorbidities |
Asthma |
| Policy |
Don't know |
| Comments |
I didn't have to deal with them they approved me within a week of my letter . They didn't stall at all . I didn't have to bother the insurance company at all they just approved me with no questions . I would highly recommend this insurance to anyone that can get it . I had no problems at all . |
| Source |
Angel P |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/04/00) |
| MD-supervised programs |
2 (152 weeks) |
| Source |
Sandra W |
| Insurer Policy |
Aetna (Patriot XV) |
| Insurer Status | Approved after first letter (04/10/01) |
| Pre-Op BMI |
44.6 |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Deena E |
| Insurer Policy |
Aetna (hmo/ppo) |
| Insurer Status | Approved after first letter (07/15/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
50.5 |
| MD-supervised programs |
4 (76 weeks) |
| Source |
Mary B |
| Insurer Policy |
Aetna (health insurance HMO) |
| Insurer Status | Approved after first letter (07/24/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
42.6 |
| MD-supervised programs |
1 (6 weeks) |
| Comorbidities |
GERD, fibromyalgia, hypertension |
| Policy |
Must be medically necessary |
| Comments |
The insurance company seems to be pretty good so far...it's the first time I've had a surgery since I've been covered by them.
I don't think they stall at all
I think they respond to me promptly and accurately
Their rates seem to be a little high, but not as high as blue cross blue shield. I'm paying 450.90 a month for me and my husband. We're 43 and 44 yrs. old. |
| Source |
Elaine W |
| Insurer Policy |
Aetna (Aetna Health Source) |
| Insurer Status | Approved after first letter (07/31/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Pre-Op BMI |
61.8 |
| Policy |
Must be medically necessary |
| Comments |
I waited for 3 weeks before I contacted my insurance agent, asking if Aetna had even gotten my paperwork.
Then I faxed Aetna requesting information on my case. Patti J. from Aetna called me the next day saying my paperwork went to the wrong address. She let me know I was approved!
The fax number for Aetna is 860-636-9415 once my surgeons office faxed my info within 24hrs I was approved, if I had it to do over I'd have faxed Aetna 3 days after my info
was sent to make sure it got to the right department. I have to say Everyone I dealt with at Aetna was extremely pleasant. |
| Source |
Wendy R |
| Insurer Policy |
Aetna (qpos) |
| Insurer Status | Approved after first letter (7/26/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
57.0 |
| Comorbidities |
Sleep apnea, arthritis |
| Policy |
Must be medically necessary |
| Comments |
They approved it right away! I was already apprehensive and ready to fight, and did not need to. |
| Source |
Lisa T |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/07/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
1 (25 weeks) |
| Comorbidities |
no co- morbidities, but severe depression |
| Policy |
Don't know |
| Comments |
Dr. Cloughs office sent the information out to the insurance, and a week later the insurance didnt have a file on me. I got a fax number and Dr. Cloughs office faxed the papers to Aetna.
I called Aetna on 11-14 and spoke to a very nice woman, she said she had some good news, and I asked, "oh, you got the paper work?" she said, no better you have been approved. I jumped out of my chair, and yelled yes! thank you. I was worried about approval from them but I had no problem at all. I called Dr. Cloughs office right after I got off the phone and they didnt have the papers yet. I checked the mail that same day and my approval letter was there. I called Dr Clough on 11-16 they still said no papers. So I took my copy up to them and a wonderful lady checked my chart and the information had already been filed, with no contact made to me for a pre surgery visit. So I am waiting till Monday 11-19 to call the office again. |
| Source |
Amber H |
| Insurer Policy |
Aetna (U.S. Healthcare) |
| Insurer Status | Approved after first letter (11/10/00) |
| Weeks to approval |
1 |
| Comorbidities |
hypertension, GERD, joint pain |
| Policy |
Must be medically necessary |
| Comments |
Aetna was incredibly easy to deal with. My bariatric surgeon's nurse faxed them a letter and before 24 hours had passed had their approval for my surgery.
I would highly recommend that if you are shopping for insurance that covers WLS, that you will enjoy Aetna's promptness and good coverage. |
| Source |
Laura P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/20/00) |
| Surgery Type |
Open VBG |
| Weeks to approval |
3 |
| Pre-Op BMI |
47.3 |
| Comorbidities |
depression, arthritis, asthma, migraines |
| Policy |
Must be medically necessary |
| Comments |
Not a single problem as of yet... |
| Source |
Kim F |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/04/00) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
64.4 |
| Source |
Ed F |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (02/07/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
38.4 |
| Comorbidities |
hypertension, depression, IBS, IT,acid reflux, endometriosis, asthma |
| Policy |
Must be medically necessary |
| Comments |
Approved without any problem. |
| Source |
Patty P |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (02/27/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| Comorbidities |
Hypertension, |
| Policy |
Must be medically necessary |
| Comments |
Aetna Qpos is great to deal with make sure your surgeon calls and pre certifies you as it will speed things up a lot. I talked with Patty J. she cut right through the red tape. What a big help. After she got the paperwork faxed to her it was 2 days. |
| Source |
Richard S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/14/01) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
63.7 |
| Comorbidities |
diabetes, GERD, hypertension |
| Policy |
Must be medically necessary |
| Comments |
Took 2.5 HOURS to get the decision once Patty (their pre-auth nurse for the NE region) had all the info she needed - -I'm still joking that I didn't think I was THAT bad off!
Dealing directly with Patty was great - she told me what she needed and I made sure she got it! |
| Source |
Christy M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (04/13/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
8 |
| Pre-Op BMI |
45.7 |
| Comorbidities |
Diabetes, structural problems, back problems, gout |
| Policy |
Must be medically necessary |
| Comments |
Once I got in touch with Aetna, they were helpful, and they rapidly approved my surgery. My advice is to contact the Insurance Co. after you see the surgeon, in about a week to see if they got the surgeons letter for a decision finding.
|
| Source |
Darlene F |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (05/04/01) |
| Surgery Type |
Open VBG |
| Weeks to approval |
1 |
| Pre-Op BMI |
50.9 |
| Comorbidities |
100pnds o.w. lower back pain, asthma, bmi,51, insomnia,depression. panic,anxiety disorder |
| Policy |
Must be medically necessary |
| Comments |
I had no problems at all, my dr, sent in tne imformation that needed to be sent and they called less than a wk later to let me know I was approved, plus I got a letter in the mail of my approvel, I was very excited. |
| Source |
Tricia B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/16/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
59.7 |
| Source |
Andrea B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (8-30-01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
7 |
| Comorbidities |
BMI of 70, knee and back problems. |
| Policy |
Don't know |
| Comments |
I kept right after them. Calling at least everyother day.
Not sure if they stall or not but it took 7 weeks to get approved.
They were always telling me it had been sent to the review board.
Keep at them if it is something you really want.
|
| Source |
Kellie H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/31/01) |
| Source |
Sarah C |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/21/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
60.5 |
| Policy |
Don't know |
| Comments |
I had to keep on top of my paperwork sent to them by the physicians office. I ended up asking the doctor office to sent info via fax after the 3rd week. I called the ins co to verify receipt and received great assistance from the woman I talked to. I ended up being approved within 3 days of the fax.
Keep in touch with the process from the doctors office to the insurance co. |
| Source |
Carolyn C |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (12/20/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
5 |
| Pre-Op BMI |
51.7 |
| Comorbidities |
Apnea, joint problems, high family history of Diabetes and heart Disease. |
| Policy |
Don't know |
| Comments |
I didn't have to deal with the insurance at all. Dr. Cobean's office submitted everything and I just got the "magical" letter of approval one day in the mail. |
| Source |
Barbara K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (02/27/02) |
| Surgery Type |
RNY |
| Pre-Op BMI |
49.2 |
| Source |
Linda R |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (9/3/03) |
| Surgery Type |
Open VBG |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.8 |
| Comorbidities |
Eclampsia in previous pregnancy, rosacea, plantar warts (due to heel cracks) |
| Policy |
Must be medically necessary |
| Comments |
Aetna will not approve the Lap Band surgery, which is what I first applied for with Dr. Aslam. They said they'd approve the VBG. So I searched until I found Dr. Margolis in Waterville, Maine. He performs that operation routinely, has done so hundreds of times.
Kathy Taylor, the R.N. I've been working with at Dr. Margolis's office, was told by Aetna that I'd need documentation of a medically supervised weight loss attempt of 6 months duration that occurred within the past two years. I panicked, because I don't have this. You all know how hard it is to get insurance to approve paying for a dietician, countless doctor visits and a gym membership. So I called the nurse handling my case at Aetna and said I'd be willing to start spending tons of their money if I have to, but maybe we could cut to the chase and she could tell me exactly what they were looking for.
Turns out, all they needed was a letter from my PCP stating that he has been aware of my several attempts to lose weight over the past year and a half. He also documented all of my conditions that could be improved by weight loss. That's all it took! |
| Source |
Lara D |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (07/13/02) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
48.7 |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
I truly can't believe how easy this was. Having this insurance now for over 3 years I have had to fight for everything with them. I expected this to be the failure in my continueing w/this surgery. I thought for sure I would have to fight with them until I just gave up. I saw my Dr. on June 10th for the first time, I called the following Monday (exactly 7 days) to see if they recv'd the paperwork, the girl was rude and told me that I was crazy to think that they would have anything that quick. She said to expect 6-8 weeks. The very next day the Dr's office called to say I was approved. I still didn't feel confident until I recv'd the letter in the mail from Aetna 2 days later. This proved to me that my having this surgery was meant to be.... |
| Source |
L F |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/09/02) |
| Source |
Kathleen R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/15/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
62.0 |
| Comorbidities |
Sleep apnea, Type 2 Diabetes, hypertension |
| Comments |
I was surprised that my insurance company didn't put up more of a fuss. They just wanted proof of at least 6 months of documentation that I was on a doctor supervised weight loss/excersize program. |
| Source |
Jane T |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/22/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
6 |
| Comorbidities |
arthritis, lymphedema |
| Policy |
Must be medically necessary |
| Comments |
I really did not have any problem, the dr had everything done prior to writting his recommendation to the inssurance co. |
| Source |
Ellen L |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (7/02/03) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
5 (304 weeks) |
| Comorbidities |
sleep apnea, hypertension |
| Policy |
Must be medically necessary |
| Comments |
approval was fast (<2 days after receipt of info from surgeon)
they did have a 6months of medically supervised weight loss effort (which I think is great)
So far, they have been great to work with |
| Source |
Kofi A |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (07/11/03) |
| Policy |
Must be medically necessary |
| Source |
Kathi G |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
47.0 |
| Policy |
Must be medically necessary |
| Comments |
Aetna was fine to work with. As long as you have all your paperwork in order. You have to have a 6 month dr.supervised weight loss and exercise program.
I kept every record...when the faxed it in, I was approved in less then a day!
|
| Source |
Kris |
| Insurer Policy |
Aetna (QPos) |
| Insurer Status | Approved after first letter (12/01/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
4 |
| Policy |
Must be medically necessary |
| Source |
Sandy M |
| Insurer Policy |
Aetna (ME SGB/HMO) |
| Insurer Status | Approved after first letter (6/21/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
39.3 |
| MD-supervised programs |
1 (6 weeks) |
| Comorbidities |
acid reflux, back & joint pain, thyriod disorder,bad bladder |
| Policy |
Must be medically necessary |
| Comments |
I was denied because I didn't hve 6mo. of suppervised diet & exrcise. Make sure you goto the insur. web site to get all th info you need before. I didn't & now 7mo. into waiting I feel like I have to start from scratch... It is very disapointing. Had I known I cold have been doing it all along.
But I say don't give up!!!!! I filed an appeal.
I just want to tell you all I had MAine Care as well &the apporved m the first time. |
| Source |
Clista W |
| Insurer Policy |
Aetna (Aetna Small Group) |
| Insurer Status | Approved after first letter (02/17/05) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
79.3 |
| Policy |
Don't know |
| Source |
Sherry W |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after 2nd appeal letter (10/8/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
57.6 |
| Comorbidities |
sleep apnea, diabetes,hienal hernia, PCOS, high colesteral |
| Policy |
Must be medically necessary |
| Comments |
So far in dealing with Aetna I have had positive experiences. The case manager told me how to get reimbursed for my pyscological consult and any follow-ups thereafter and also for the nutritionalist!
Updated 2/1/05 I have changed my opion of Aetna this has been a horrible last two months dealing with Aetna.
I have had nothing but problems I can not get a supervisor, I keep gettting the run around as I tried to get a 2nd appeal going. The customer service people could not make up thier mind where the appeal should be mailed, every time I talked to someone different I got a different answer!
It is so ridiculous
|
| Source |
Davina K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (07/01/04) |
| Surgery Type |
Laparoscopic Other |
| Source |
Kenny W |
| Insurer Policy |
Aetna (Choice POS II) |
| Insurer Status | Approved after 2nd appeal letter (09/23/06) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
60 |
| Comorbidities |
arthritis, asthma |
| Policy |
Must be medically necessary |
| Comments |
Aetna was terrible to deal with. They did not respond to letters, did not return phone calls, requested information they already received, requested documentation not required by the policy and sent a letter to the hospital stating that they were not the primary carrier when they been our only carrier for two years.
They only reponded when I complained to their excutive office.
My suggestion would be to document every contact with Aetna. If problems are encountered, call their excutuve office in Hartford, CT. |
| Source |
Beach B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/15/04) |
| Surgery Type |
Open RNY - distal |
| Comorbidities |
type2DM, deep talon arthritis and heel spurs, transient HTN, GERD, migraines |
| Policy |
Must be medically necessary |
| Source |
Heather E |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (08/24/04) |
| Policy |
Don't know |
| Source |
Patricia D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/16/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
arthritis both knees, ddd, htn, borderline diabetis, high cholestrol, gerd, |
| Policy |
Must be medically necessary |
| Comments |
I have not had any problems with Aetna
No stalling
can tell
Make sure that you know before hand what the requirements are from the insurance company and follow it to the letter. Document everything from the people you speak with, dates, time, what is said. Document, Document, Document it is priceless. |
| Source |
Joan M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/28/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
47.3 |
| Comorbidities |
High Blood Pressure, Acid Reflux, Depression |
| Policy |
Written exclusion policy |
| Comments |
Dr. Wolff's office did all the work with the insurance I didn't have to do much. All I had to do was get them some past weight information, and some info from my doctor's office. They approved me in two or three days. |
| Source |
Becky G |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/21/05) |
| Source |
Lori G |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | (09/12/05) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
42.6 |
| Policy |
Don't know |
| Comments |
I had maine care along with Aetna and the hoops that Aetna wanted me to jump thrugh was unbelievable and I cancelled my policy. After several years of complaining to my PCP about my weight Aetna wanted me to go through 6 months that were consecutive in order to possibly grant the surgery. |
| Source |
Juju B |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (02/16/2006) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
39.9 |
| Comorbidities |
Depression, Hypertension |
| Policy |
Must be medically necessary |
| Comments |
Aetna has been surprisingly good so far. They have covered all the pre-op testing and appointments I have had and they approved my surgery on the first try. As far as dealing with them, they were OK, but you can never speak to the same person twice. I don't think they stalled much. I recommend calling your insurance company daily--I even called more than once a day a few times! |
| Source |
Andrea B |
| Insurer Policy |
Aetna (Aetna PPO) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Source |
Melissa T |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after appeal letter (April 10, 2007) |
| Weeks to approval |
6 |
| Pre-Op BMI |
37.3 |
| Comorbidities |
Insulin Dependent Diabetes, GERD, Stress Incontinence, HTN, |
| Policy |
Must be medically necessary |
| Comments |
The greatest frustration has been with my surgeons's office staff not acting on time-sensitive material which was on the desk for 2 weeks. There was a 14 day window of opportumity for the Peer to Peer Review. Nothing happened - On day 14, the secretary still had not oppened the letter from the insurance company which requested a peer to peer review. As a result, my original surgery date of May 2nd had to be re-scheduled because I was denied. New surgery date is May 23rd. Insurance (Aetna) approved surgery. |
| Source |
Rachel K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
53.5 |
| Source |
Darcy M |
| Insurer Policy |
aetna (hmo) |
| Insurer Status | Approved after 2nd appeal letter |
| Surgery Type |
Laparoscopic Lap Band |
| Source |
April B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/11/08) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
Sleep Apnea, High Blood Pressure |
| Policy |
Don't know |
| Comments |
Aetna was easy to deal with. Everytime I called, which was everyday, they took the time to answer my questions. My doctors office did all the faxing of the paperwork and made sure we sent everything they required. I would recommend Aetna to anyone planning on having this surgery. |
| Source |
Julie W |
| Insurer Policy |
Aetna (W1514 26140) |
| Insurer Status | Denied after legal action taken |
| Comorbidities |
Diabetes, Hypertension, Depression |
| Source |
Claudia M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Depression, Shortness of breath |
| Source |
Jennifer C |
