| Adventist Health |
|---|
| Insurer Policy |
Adventist Health |
| Insurer Status | Approved after first letter (03/07/03) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
43.3 |
| MD-supervised programs |
4 (131 weeks) |
| Comorbidities |
hypertension, arthritis in lower back, depression |
| Policy |
Written exclusion policy |
| Comments |
In the time since my original request our hospital (I am a nurse) started a bariatric program. Now that the program is in place I decided to try again...still the answer was no.After being denied I went to the CFO of the hospital and discussed the issue with him. He told me not to give up...that he was going to address it with the benefits people and see what he could do. I told him I was going to look for another job so I could find insurance that would cover it.
Keep your fingers crossed...he did say that I would be able to have the hospital "finance" the surgery if I cannot get it covered. I will do this one way or another.. I am tired of being depressed, my body hurting after a 12 hour shift, fearing my health worsening etc.
Update: My employer has denied coverage of the surgery but is making a special arrangement for me to have the surgery at a discounted rate and repay it over 3-4 years. This is acceptable to me. I don't want to leave my job.
|
| Source |
Carolyn R |
| aeina |
|---|
| Insurer Policy |
aeina (ppo) |
| Insurer Status | Approved after first letter (12/12/05) |
| Comorbidities |
Arthritis, Depression, Hypercholesterolemia, Shortness of breath, Sleep apnea |
| Source |
T T |
| Aethna |
|---|
| Insurer Policy |
Aethna |
| Insurer Status | Approved after first letter (02/02/04) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
47.8 |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Tasha S |
| Aetna |
|---|
| Insurer Policy |
Aetna (Managed Choice) |
| Insurer Status | Approved |
| Comments |
After receiving the dr.'s request, they required proof of past failures which I had already had forwarded to my dr. The approval followed shortly thereafter. |
| Source |
Mary H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/09/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
45.5 |
| Comorbidities |
sleep apnea, joint pain, shortness of breath on exertion |
| Policy |
Must be medically necessary |
| Comments |
They were great once I called and found out that the letter should have gone to one unit and it was sent to another. Dr. Vanguri's office faxed the letter right over and in less than 48 hours I was approved. |
| Source |
Carla K |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (10/22/99) |
| Comments |
Approved very quickly. |
| Source |
Dawn P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/07/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
46.1 |
| MD-supervised programs |
1 (20 weeks) |
| Comorbidities |
Sleep apnea, GERD, bmi 46 |
| Policy |
Must be medically necessary |
| Comments |
I didn't really have to deal with my insurance company at all. Dr. Lin's office handled the paperwork and dealt with them directly. I expected to be denied and thought I would have to appeal, but luckily everything went through the first time. |
| Source |
Becky D |
| Insurer Policy |
Aetna (Aetna US Healthcare) |
| Insurer Status | Approved after first letter (1/3/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.8 |
| MD-supervised programs |
4 (84 weeks) |
| Comorbidities |
Back problems, high colesteral, few co-morbidities |
| Policy |
Must be medically necessary |
| Comments |
Aetna was very good and willing to approve. We actually changed our insurance To Aetna from what we had read on this website. It appears that many folks with Aetna have little or no problems getting approval. Also, the State of Maryland has passed a law that only small or self-insured Maryland employers can exclude WLS from their medical insurance coverage. |
| Source |
Susan H |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (05/05/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| MD-supervised programs |
3 (44 weeks) |
| Comorbidities |
sleep apenea, chronica back pain, high blood pressure reflux disease |
| Policy |
Must be medically necessary |
| Comments |
They will not let you know- they will call the surgeon and tell them, I called and asked directly and they said they had contacted the surgeon. |
| Source |
Elizabeth S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/24/00) |
| Surgery Type |
Open RNY - distal |
| Source |
Dawn H |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (04/12/00) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
1 (45 weeks) |
| Comments |
5/2/00 I called insurance co. and they
have lost my paper work.talked to connie at dr.office and they are faxing a copy to the insurance co.so i'm still waiting. the waiting is driving me crazy.
5/4/00 up date 48 hours after they recieved my letter i was approved,they lost it ,now i'm on my way. |
| Source |
Sue C |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/1/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
39.2 |
| Comorbidities |
back problems, shortness of breath on exersion |
| Comments |
I was very suprised and overjoyed that the surgery was approved extremely quickly with no other "proof" requested. I am 122 pounds over my ideal weight, but am in good shape considering. We figured we'd have a fight on our hands, but Aetna was EXCEPTIONAL! |
| Source |
Gail G |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/18/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
58.5 |
| Comorbidities |
sleep apnea, arthritis, hypertension, Barrett's |
| Policy |
Must be medically necessary |
| Comments |
The doctor's office sent all the paperwork to them. I have not had any problems with them yet. Just make sure you have all your paperwork ready and in order. |
| Source |
Laurie F |
| Insurer Policy |
Aetna (managed care) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open RNY |
| MD-supervised programs |
3 (64 weeks) |
| Policy |
Must be medically necessary |
| Source |
Laurie |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (10/30/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
64.7 |
| MD-supervised programs |
1 (10 weeks) |
| Comorbidities |
GERD, Sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
I am amazed at how quickly and effortlessly it has been to deal with AetnaUSHC. I got approved in a week and without one hassle! I am pleasantly suprised and recommend them highly. They gave me no problems whatsoever with any of the numerous referrals either. I didn't have to call or deal with them myself. The wonderful staff at the Dr's office dealt with them...I would recommend them! I recommend a METICULOUS diet history and a good doctor's letter of referral...Also, write a overly emotional letter of how much your weight has affected your life!!!!!!!!! |
| Source |
Christine C |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (07/17/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
42.0 |
| MD-supervised programs |
1 (24 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I did not have to deal with the insurance company at all.Aetna aproves almost all bariatric surgery except for band and a couple of others I can not remember. Just write your letter from your heart and the doctor will do the rest. |
| Source |
Shelly B |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (07/20/00) |
| Weeks to approval |
1 |
| Pre-Op BMI |
80.5 |
| Comorbidities |
sleep apnea, pulmonary hypertension, asthma, arthritis |
| Policy |
Don't know |
| Comments |
Aetna approved my surgery quicker than I thought they would. It was easier getting approval for WLS than to get a wheelchair. |
| Source |
Diana G |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (5/05/2001) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
51.1 |
| Comorbidities |
Arthritis, Snoring, High Cholesterol |
| Policy |
Must be medically necessary |
| Comments |
MAMSI DENIED MY INITIAL REQUEST (LETTER FROM SURGEON) WITHIN 3 DAYS. IT WAS ADMISTRATIVELY DENIED BASED ON A CONTRACT EXCLUSION, AND NEVER EVEN WENT TO CLINICAL REVIEW. I AM SENDING MY FIRST APPEAL LETTER 11/27/00 (9 PAGES PLUS REFERENCES & DOCTOR'S LETTERS) WE WILL SEE HOW PERSISISTENCE PAYS OFF BECAUSE I PLAN TO BE A PAIN IN THEIR BACKSIDE.
They flatly denied my appeal and said I had exhausted my appeal options. (see personal info for more details) Small group policies have specific problems in Maryland.
Changing to Aetna eff. April 1, 2001. They should approve it!
8/21/01: They approved it in May, and I am finally scheduled for 9/10/01! |
| Source |
Lisa B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/22/00) |
| Source |
Diane H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/25/00) |
| Surgery Type |
Open RNY - proximal |
| Comorbidities |
Sleep apnea, severe arthritis, family history of stroke, heart disease |
| Policy |
Must be medically necessary |
| Comments |
I was so surprised with my insurance company!!! I faxed my primary physicians letter of support along with a letter from me Friday morning and by Monday morning my doctors office had the approval!! It was great!!! The only frustrating part was trying to verify that the insurance company actually received the fax!!! But gee guess the right person picked up my fax and flew with it!!!The only advise I can give is to make sure your primary lists all your co-morbidities and your history of dieting.... Good luck! |
| Source |
Sandy M |
| Insurer Policy |
Aetna (mcn) |
| Insurer Status | Approved after first letter (01/29/01) |
| Surgery Type |
Laparoscopic Duodenal Switch |
| Pre-Op BMI |
44.5 |
| MD-supervised programs |
2 (14 weeks) |
| Comorbidities |
NONE |
| Policy |
Must be medically necessary |
| Source |
Jamie C |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/06/00) |
| Surgery Type |
Open RNY - distal |
| Source |
Michelle H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (04/23/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
5 |
| Policy |
Don't know |
| Comments |
They do respond to persistance. I called once a week until I got an answer. I was also able to get them to fax me a copy of the approval letter that they mailed to my surgeon's office, which they did while I waited on the phone. I would recommend that if anyone has Aetna that they find out exactly where the initial paperwork should be sent. Mine was first sent to precertification when it should have been sent to predetermination. |
| Source |
Traci D |
| Insurer Policy |
Aetna (FEHBP) |
| Insurer Status | Approved after first letter (12/11/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
62.8 |
| Comorbidities |
Arthritis, Sleep Apnea, High Blood Pressure, Thyroid |
| Comments |
They were very easy to deal with. They do not stall at all. Yes. With the plan I have, it states that they will cover this surgery for those that are 100+ pounds overweight. Each time I called them, they were very helpful. It took longer for the letter to go out from the doctor's office than to get approved by the insurance. Only because the office was so filled with patients. |
| Source |
Linda T |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (01/12/01) |
| MD-supervised programs |
2 (56 weeks) |
| Source |
Mary C |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/31/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
61.8 |
| MD-supervised programs |
5 (170 weeks) |
| Policy |
Don't know |
| Comments |
They were wonderful, even though they said they didn't have the letter or the fax, when it was resent it was immediately approved |
| Source |
Denise C |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/23/01) |
| Surgery Type |
Laparoscopic Duodenal Switch |
| Pre-Op BMI |
53.4 |
| MD-supervised programs |
2 (16 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I am one of the extreme exceptions-I was approved within 24 hours after seeing my Dr. for the first time. I also didn't have go through the hassle of getting a referral from my PCP to my surgeon. From everything that I have read about Aetna so far-it is a great insurance to have. |
| Source |
Dee Dee U |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/10/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Pre-Op BMI |
47.9 |
| Comorbidities |
diabetes |
| Comments |
had no problems they were great! |
| Source |
Keni B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (1/01/02) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
3 |
| Comments |
Well according to my new insurance policy, Aetna, they cover the surgery 100%
We'll see. I go for my consult Dec. 10, 2001.
Well I finally got my approval. I kept calling the insurance company and
they finally told me it was approved. It took about 3 weeks total. But thats
because the insurance girl at the surgeon's office took a week or two to send
it in. After they received it, it took about 10 days. |
| Source |
Suzanne E |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (1/30/02) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
2 (88 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I started out with M.D.I.P.A. ins ( they were pure H--- to deal with!!! I switched during open season. I went with Aetna and once the Dr.s office called for the auth.#,approval was given over the phone.
I would recomend Aetna to anyone. |
| Source |
Susan K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (6/99) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.0 |
| Comorbidities |
Hypertension, heel spurs, borderline Diabetic |
| Policy |
Don't know |
| Source |
Wanda M |
| Insurer Policy |
Aetna (Amtrak) |
| Insurer Status | Approved after first letter (02/24/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
50.4 |
| Comments |
I was approved in 3 days. No trouble at all. |
| Source |
Jill D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/02/01) |
| Surgery Type |
RNY - proximal |
| Weeks to approval |
01 |
| Comorbidities |
sleep apnea, GERD |
| Policy |
Must be medically necessary |
| Source |
Margaret W |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (03/24/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
1 |
| Comorbidities |
arthritis, asthma |
| Policy |
Must be medically necessary |
| Comments |
I did not have to deal with them at all. My doctor took care of everything and I was approved in less than a week!! Aetna is the BEST!!!!! I did send along a personal letter with photos and I think that helped out a lot. |
| Source |
Dana N |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/15/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
48.7 |
| Comorbidities |
Severe arthritis in both knees, hypertension, liver disease, sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
I did not have to deal with my insurance company because Dr. Lin's staff took care of it all. I prepared a written diet history before my first appt. with Dr. Lin and his staff used that information to fill out the paperwork. Make sure you have two physician monitored diets listed.
I was approved in 24 hours. |
| Source |
Ruth W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (04/08/01) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
53.3 |
| Source |
Karen Z |
| Insurer Policy |
Aetna (Us Health Care) |
| Insurer Status | Approved after first letter (04/04/01) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
42.7 |
| Policy |
Don't know |
| Source |
Kaye J |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (06/15/01) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
61.3 |
| Policy |
Must be medically necessary |
| Comments |
THEY RESPOND VERY QUICKLY AND I HAD NO PROBLEMS. ALWAYS GET THE NAME OF THE PERSON YOU SPOKE WITH. |
| Source |
Andrea S |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after appeal letter (05/10/01) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
48.4 |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
Arthritis, Borderline Diabetic |
| Policy |
Must be medically necessary |
| Comments |
Well, I haven't had to deal with Aetna really because my PCP and Dr. Provost's office is taking care of all the details. However, I found out at my first consultation that they require (2) medically supervised diet plans.
What I suggest to all who are considering this surgery. PLEASE PLEASE get ALL of your medical history from your doctors. And while you are still researching the WLS, please get your doctor or independent specialist to document you trying to lose weight. |
| Source |
Deidra R |
| Insurer Policy |
Aetna (Microsoft) |
| Insurer Status | Approved after first letter (06/04/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
45.6 |
| Comorbidities |
GERD, plantar fasciitis, borderline hypertension |
| Policy |
Must be medically necessary |
| Comments |
I called them and was told "no problem". My BMI is over 40 so it's an approval. I'll let you know if that rings true.
Claim submitted on 6/1/01, a Friday, and approved on Monday! I had to convince the doctor's office they could submit without documenting co-morbidities. When they finally submitted it, I had approval the next business day. Thanks Bill, love the MS insurance.
Processing went great too. No hold ups or problems and I'm 10+ months out. |
| Source |
Karen S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/23/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
53.4 |
| MD-supervised programs |
1 (32 weeks) |
| Comments |
Well Aenta Has been pretty good to me, even though they are an HMO. You have to have a referal for eveything. That was the only complaint that i have had.We will see if they will stall with the approval process.
I will be calling them the second week in Feb. to see if i have been approved....Wish me luck..:0) |
| Source |
Kara E |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (07/16/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
44.4 |
| Comments |
I was approved with a letter of medical necessity and a history of failed weight loss programs. I was amazed at the speed and ease of the approval process. |
| Source |
Bill C |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/30/01) |
| Weeks to approval |
1 |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
Diabetes, Hypertension |
| Policy |
Must be medically necessary |
| Comments |
The woman I dealt with at Aetna was very nice and helpful. I have to give special thanks to my UNION... CWA - Communications Workers of America, If they had not made this a priority in our last round of bargaining, I would probably not be having this done. |
| Source |
Renee B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/16/02) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
52.9 |
| MD-supervised programs |
2 (29 weeks) |
| Comorbidities |
hypertension,sleep apnea,shortness of breath |
| Policy |
Must be medically necessary |
| Comments |
I didn't have any involvement with my insurance company. Dr. Roe's office took care of everything. |
| Source |
Dvines O |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | First letter sent - still waiting (06/19/01) |
| Source |
Steven W |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (07/04/01) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
2 (20 weeks) |
| Source |
Jamie G |
| Insurer Policy |
Aetna (MCA) |
| Insurer Status | Approved after first letter (12/19/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.1 |
| MD-supervised programs |
1 (32 weeks) |
| Comorbidities |
hypertension, joint pain |
| Policy |
Don't know |
| Comments |
I actually had no dealings with the insurance company. Dawn at Dr. Roe's office took care of everything. Paperwork was submitted on 12/7, and I received approval on 12/19. I have absolutely no complaints! |
| Source |
Munchkin I |
| Insurer Policy |
Aetna (ups flex hmo) |
| Insurer Status | Approved after first letter (09/20/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
43.9 |
| MD-supervised programs |
2 (33 weeks) |
| Comorbidities |
bilateral plantar fascitis. Calcaneal spurs, shortness of breathe, trouble sleeping |
| Policy |
Must be medically necessary |
| Comments |
Letter got lost in the mail room so they accepted a fax. They approved the surgery within 24 hours of the fax. |
| Source |
Tracy F |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (10/22/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| MD-supervised programs |
1 (36 weeks) |
| Comorbidities |
hypertension, sleep apnea, joint pain, urinary incontince |
| Policy |
Must be medically necessary |
| Comments |
I said a prayer and then shopped around for insurance. |
| Source |
Paula A |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (07/26/01) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
40.2 |
| Source |
Yvonne P |
