| |
|---|
| Insurer Policy |
|
| Insurer Status | |
| Surgery Type |
Laparoscopic Vertical Sleeve Gastrectomy |
| Policy |
Don't know |
| Source |
Gayle S |
| Insurer Policy |
( ) |
| Insurer Status | Denied after appeal letter |
| Comorbidities |
Depression, Shortness of breath, Stress incontinence |
| Source |
Debra S |
| First Health-MCHP |
|---|
| Insurer Policy |
First Health-MCHP |
| Insurer Status | First letter sent - still waiting |
| Comorbidities |
Sleep Apnea, hypertension |
| Policy |
Must be medically necessary |
| Comments |
Working for the state you have to reenroll in a medical plan every October. I use to have United HealthCare. I submitted all of my paperwork to them in August. I did not hear from them until December that they did not cover Baratric Surgery through my employer. I sent an appeal letter. Since I contacted the MCHP that handles the contracts with the insurance companies I received 3 letters from UHC in January rejecting the appeal. The State of Missouri did not renew the contract with UHC in July. So far he only issue I have with First Health is that you have to contact them directly to find out what the criteria is for them to cover baratric surgery. If I had known in October I would have had 6 months of physican supervised diet plan. I waited until January to send my paper work in for approval with the insurance company telling me that I need documented o fa physican supervised diet plan. I may have to wait until July or August for the surgery. |
| Source |
Vanessa M |
| Medicare Part A & B |
|---|
| Insurer Policy |
Medicare Part A & B |
| Insurer Status | Approved after first letter (5/24/06) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
49.4 |
| Comorbidities |
sleep apnea, arthritis, hypertension, diabetes, fibromyalgia, divertriculosis, hypercholesterolemia, |
| Policy |
Written exclusion policy |
| Source |
Karen S |
| Mo medicaid/medicare |
|---|
| Insurer Policy |
Mo medicaid/medicare |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY - distal |
| Policy |
Don't know |
| Source |
Tammy B |
| Access Medical |
|---|
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (02/22/04) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
2 (85 weeks) |
| Source |
Linda N |
| AdminOne/Med Care One |
|---|
| Insurer Policy |
AdminOne/Med Care One |
| Insurer Status | Approved after first letter (2005) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
40.0 |
| Comorbidities |
PseduoTumor Cerebri, Multiple other Neurological Problems, Insulin Resistant, Back, Hip, and Knee pa |
| Policy |
Must be medically necessary |
| Comments |
My insurance company was very nice to deal with. For each company they insure they appoint specific individuals to deal with any questions. Mary (nurse for my doc) was able to fax them all my medical records and other information for review. We was told that a date and time had been assigned to sit with the medical examiner and go over the documents. (We sent a lot.) I also wrote a letter to the insurance provider about the growing statistics related to obesity and how my medical problems are all connected to it. I asked them to consider the cost for continuing to treat my multiple co-morbids verses WLS cost. They were very effective in getting me an approval. I am very happy with them. |
| Source |
Randelhia M |
| Aenta |
|---|
| Insurer Policy |
Aenta |
| Insurer Status | Approved after first letter (Feb 07) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
1 |
| Pre-Op BMI |
61.6 |
| Comorbidities |
none other than PCOS |
| Policy |
Must be medically necessary |
| Comments |
We had done all the work with our preference insurance Coventry/First Health. Our employee changed companies in Jan, but kept the same requirements, so everything was very easy. We had our charts for 5 years and letters of recommendations from PCP and my GYN, along with our Weight Watcher tracker, they approved us immediately. (husband and I are both having the band - 3 weeks apart) |
| Source |
Missy E |
| Aetna |
|---|
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (08/01/2003) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
50.1 |
| Comments |
Aetna was wonderful...just applied and they approved..as simple as that..
My previous insurance denied me for 5 years- they were the Indiana Pipe Trades health and welfare plan..poor, poor, POOR insurance!!! |
| Source |
Elaine R |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (01/26/00) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.8 |
| Comorbidities |
Arthritis,possible diabeties |
| Policy |
Must be medically necessary |
| Comments |
I was actually amazed that I was
approved for the surgery after my first
letter was sent in. I just gave my info to
Janet ( Midwest Bariatric,Dr's Hosp in
Wentzville,Mo) and she sent in the request on
Sept 13th and I got my approval dated the
30th of Sept on Oct 9th. So, I would say I'm
really pleased how this has gone so far.
|
| Source |
Tammy P |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (07/29/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| MD-supervised programs |
3 (15 weeks) |
| Source |
Ginny S |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (02/15/00) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
36.7 |
| Comments |
Aetna was wonderful. I was approved after only 3 weeks. No complaints from me! |
| Source |
Tami G |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (01/10/00) |
| Source |
Heather R |
| Insurer Policy |
Aetna (USAccess) |
| Insurer Status | Approved after first letter (6/6/01) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
42.9 |
| MD-supervised programs |
2 (28 weeks) |
| Comorbidities |
High Blood Pressure |
| Policy |
Must be medically necessary |
| Comments |
I didn't have to deal with them at all. Janet at Midwest Bariatrics took care of all of it. I called Aetna on June 5th to see if they had everything they needed. They said yes, the request was sent in that day, but a determination had not been made. I got a letter on June 11th dated June 6th saying I was approved. It took them only one day!
8-10-01 UPDATE--I found out I only have a $10 copay for the entire procedure! That saves me $90!! Yeah! |
| Source |
Jennifer |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (01/26/00) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
45.6 |
| Source |
Dawn C |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/08/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
8 |
| Pre-Op BMI |
70.6 |
| Comorbidities |
hyper tension backpain breathing problems |
| Policy |
Must be medically necessary |
| Comments |
They requested all my medical and left no stone unturned. |
| Source |
Andrew R |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (02/18/00) |
| Source |
Sheila R |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (05/23?/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
56.8 |
| Comorbidities |
hypertension |
| Policy |
Don't know |
| Comments |
I did not deal with the insurance at all. The wonderful staff at the New Start Program, mainly Chris, took care of everything for me. |
| Source |
Christina E |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (05/08/00) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
47.5 |
| Comorbidities |
arthritis, borlerline hypertension, beginning to show glucose intolerance |
| Policy |
Don't know |
| Comments |
Received approval May 7, 1st letter sent April 18. Janet at Midwest Bariatrics handled the paperwork, I've heard she's a miracle worker. |
| Source |
Donna G |
| Insurer Policy |
Aetna (U S Healthcare, EPO) |
| Insurer Status | Approved after first letter (8/15/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
5 |
| Pre-Op BMI |
72.8 |
| MD-supervised programs |
2 (42 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Dr. Scott's ofc did everything I never had to talk to the insurance company!! |
| Source |
Patricia H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (07/17/00) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
2 (12 weeks) |
| Source |
Susan R |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (10/1/01) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
51.7 |
| Source |
Carol B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (10/12/00) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
2 (39 weeks) |
| Comorbidities |
Arthritis |
| Policy |
Must be medically necessary |
| Comments |
Aetna Open Choice (primary) - denied within 2 weeks of request. Aetna indicated that they needed proof of physician supervised weight loss programs. As of 10/12/00 I have filed an appeal and faxed it to their Retro Review and Appeal department. Hope to hear something positive soon. On 10/24/00, I contacted the Retro Review department. The medical director approved the surgery. Aetna was awful initially. It's very difficult to get someone on the phone in Review and Appeal. *remember when you get a recording on the phone/voice mail - you can usually hit zero to get someone else in the department.* That's what helped me. Everytime I'd call Aetna - they'd send me to a voice mail box for the RetroReview Department. . .during the recording I'd hit "zero" and end up with a rep. Of course I apologized profusely :-) . I believe that people genuinely want to be helpful - and that's what I found with the review team. The gal I even talked to (and had been working with) said "congrats - you worked hard for this. . ." I think it helped that I submitted a letter citing quotes from the NIH, C. Everette Koop and the Journal of the American Medical Association. I also provided a listing of people to them (that I met through this website) that had Aetna insurance and were approved with varying comorbidities and some with/without physician supervised weight loss history.
US Healthcare (secondary) - surgery is approved as long as I go to an IN NETWORK physician. The doctor that I wanted to see is in US HEALTHCARES network, but not in MY network. . . . so, if I want to utilize this insurance - I've got to switch doctors. problem is - there is no doctor in my network that will do this surgery laprascopically. |
| Source |
Teresa M |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/21/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
56.2 |
| Policy |
Must be medically necessary |
| Comments |
When I talked to them they said if it was medically necessary there would be no problem and there was not. |
| Source |
Teresa L |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (January 2001) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
5 |
| Comorbidities |
Asthma, MCL Knee Injury |
| Policy |
Must be medically necessary |
| Comments |
I never had to deal with Aetna directly. Janet, the Midwest Bariatrics coordinator handled all of the precertification paperwork. She is great! |
| Source |
Jana N |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (9/7/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
46.6 |
| MD-supervised programs |
2 (43 weeks) |
| Policy |
Must be medically necessary |
| Comments |
My surgeon sent my letter to Aetna on August 23, 2001. I received a call on 9/7/01 saying I was approved. The New Start program did all the paperwork for me. I did find New Start to be a little frustrating as it took them almost 2 months to prepare my letter of necessity. However, once the letter was sent to my insurance company, it only took them 2 weeks to approve me. I guess New Start knows what they are doing since I was approved quickly with the first letter. For anyone else using New Start, my advice is to send them ALL your medical records, letter of necessity from PCP, and any other supporting documents you may have in with the original info packet they send to you. A lot of time was wasted on retreiving documents I didn't know they would need or want. |
| Source |
Rene H |
| Insurer Policy |
Aetna (Elect Choice) |
| Insurer Status | Approved after first letter (October 2000) |
| Surgery Type |
Laparoscopic Other |
| Weeks to approval |
2 |
| Pre-Op BMI |
39.2 |
| Comorbidities |
Diabetes, Cardiomyopathy |
| Policy |
Must be medically necessary |
| Comments |
They were quick on approval and have been quick on payment. They have paid 90% of everything. There was no stalling. The hardest part was finding the right person to speak to. Other than that they were great to work with. |
| Source |
Margaret B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (04/25/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
45.2 |
| MD-supervised programs |
1 (8 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Am still waiting to hear from the insurance company. There has been some problems with my surgeon. He isn't taking any new patients so I have to see another surgeon. New Start has sent my information to in the insurance company so I just wait until then. Am getting extremely anxious and nervous about this.
4/30/02: AM OFFICIALLY APPROVED AFTER AN APPEAL PROCESS. INITIALLY DENIED BECAUSE OF NEEDING ADDITIONAL DOCUMENTATION. INFO PROVIDED PLUS RESEARCHED DOCUMENTATION AND LONG LETTER OF REQUEST. DON'T EVER GIVE UP ON THOSE INSURANCE COMPANIES. KEEP TRYING! |
| Source |
Darlene G |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (08/28/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Policy |
Don't know |
| Comments |
I didn't have to deal with them. Weight for life did all that. I don't know about recommending them to anybody, but more and more insurance companies are approving the surgery |
| Source |
Shannon K |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (05/28/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
46.0 |
| MD-supervised programs |
3 (27 weeks) |
| Comorbidities |
Asthma, Sleep Apnea, candidate for heart disease, candidate for Gout |
| Policy |
Must be medically necessary |
| Comments |
I have submitted all of my documentation to Dr Juarez's office for submission to Aetna..at this point it is a waiting game..I will update as i know more :O)
7/23/01
I just got my notification that I am approved!! I am now waiting for a surgery date but have been told it will be in early October! I am truly thrilled with Aetna's turnover time, My information got sent this morning and I got my approval this afternoon! I am amazed!! I didn't have to deal directly with them at all...Dr Juarez's office dealt with them for me..I would recommend Aetna to everyone, they truly are a wonderful insurance plan! |
| Source |
Stephanie H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (05/04/01) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
62.5 |
| Policy |
Don't know |
| Source |
Benjamin W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/23/01) |
| Surgery Type |
Open RNY |
| Source |
Lisa R |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Denied after legal action taken (04/20/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
48.8 |
| Source |
Randall C |
| Insurer Policy |
Aetna (Tyco) |
| Insurer Status | Approved after first letter (05/23/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
66.4 |
| Source |
Sandra B |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (05/23/01) |
| MD-supervised programs |
3 (38 weeks) |
| Source |
Donald K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (08/01/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
4 |
| Comorbidities |
Sleep apnea, hypertension, elevated blood sugar levels |
| Comments |
Must have six month supervised diet, exercise, and nutritional counseling. |
| Source |
Brian H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/21/02) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
50.1 |
| Comorbidities |
back sugery, knee surgey, diabetes in my family on both sides |
| Policy |
Must be medically necessary |
| Source |
Darlene S |
| Insurer Policy |
Aetna (PCP) |
| Insurer Status | Approved after first letter (03/04/02) |
| MD-supervised programs |
2 (32 weeks) |
| Source |
Edith B |
| Insurer Policy |
Aetna (managed choice) |
| Insurer Status | Denied after 2nd appeal letter (07/30/01) |
| Policy |
Written exclusion policy |
| Comments |
They denied me because of not having a history of Doctor supervised diets. |
| Source |
Marsha W |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (07/21/01) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
47.7 |
| Comorbidities |
Hypertension ,Type 2 Diabetes, Arthritis, GERD, & Sleep Apnea |
| Policy |
Must be medically necessary |
| Comments |
Dealing with my insurance company was actually quite easy.
They had approved me for diet pills every since Fen-Phen was out, (now on Xenical). Therefore, they had a history of my weight loss efforts.
Be sure to fill out all forms completely and accurately. Also, make sure your primary care doctor includes with your pre-cert papers his recommendation and why.
I did follow-up with the surgeons office to make sure papers were sent in a timely manner, and I also checked with the insurance company twice to find out the status. I got my approval two days after my last phone call. |
| Source |
Shirley S |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after appeal letter (02/27/02) |
| Surgery Type |
RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
51.2 |
| MD-supervised programs |
3 (2 weeks) |
| Comorbidities |
Diabetes, reflux, shortness of breath, swelling of lower extremeties, hypertension, sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
Surgeon's ofice sent first letter mid February. I was denied pending more proof at failed physician supervised attempts to lose weight. I took it upon myself to go through ALL of my records and I pulled out all of the notes on my attempts at weight loss. I faxed those 18 pages to Aetna on 2/25/02. When I got home from work on 2/27/02 I had a message from the surgeon's office that I had been approved. Please, everyone, make sure the surgeons office is sending copies of your actual medical records and not just a letter they typed up. This would have saved me a lot of heartache if I would have know that the surgeon's office did not actually send my records. |
| Source |
Stacy S |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (11/06/01) |
| MD-supervised programs |
2 (9 weeks) |
| Source |
Kristen J |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (09/08/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Policy |
Must be medically necessary |
| Comments |
Dealing with them was fine but I write appeal letters for a living so I knew how to get the letter responded to quickly and with a positive result |
| Source |
Kelly V |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/19/01) |
| Weeks to approval |
2 |
| Comorbidities |
Sleep Apnea, sever back issues, hypertension |
| Policy |
Must be medically necessary |
| Comments |
My experience went very smoothly,no stalling.
I would and have recommended this company many times. |
| Source |
Geney S |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (09/30/01) |
| MD-supervised programs |
3 (192 weeks) |
| Source |
Denise G |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (02/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
08 |
| Pre-Op BMI |
53.3 |
| Comorbidities |
diabetes,asmtha,back problems, |
| Policy |
Don't know |
| Comments |
I was frustrated mostly on the time it took to get the approval. but once I got the approval it was real fast. and I didnt have any complecations afterwords. New Start did every thing for me. I never even had to spk with aetna.
Make sure you have patience. |
| Source |
Mary G |
| Insurer Policy |
Aetna (MC) |
| Insurer Status | Approved after first letter (11/21/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
59.1 |
| Comorbidities |
Sleep apnea, Type 2 Diabetes, chronic knee problems |
| Policy |
Don't know |
| Comments |
Aetna was pretty good! I had heard horror stories about 8 week waits and such, but I must have been lucky! Once all of the paperwork was submitted, I received approval after one week. Mind you, I did call them every day to ensure that they were working on my file, but it was worth it. Once I got the right numbers to call, the ladies answering were pleasant and very understanding. |
| Source |
Alisa B |
| Insurer Policy |
Aetna (MC) |
| Insurer Status | Approved after first letter (05/26/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
42.4 |
| MD-supervised programs |
1 (8 weeks) |
| Comorbidities |
degeneritive disc disease and arthritis |
| Policy |
Must be medically necessary |
| Comments |
The staff at the New Start Program took care of submitting my information to the insurance company. It took a long time to get together all the forms and information that the New Start program required before they would submit my information to the insurance company. I suspect they wanted to be sure my insurance company wouldn't have a reason to deny me once everything was sent in. I was approved within two weeks on my first attempt. |
| Source |
Kelly S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/01/02) |
| Surgery Type |
Open VBG |
| Weeks to approval |
4 |
| Pre-Op BMI |
49.7 |
| Comorbidities |
Mild Sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
Dealing with Aetna was wonderful. They were very responsive and only took four weeks to approve. |
| Source |
Pamela H |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (03/19/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
8 |
| Pre-Op BMI |
66.4 |
| Comorbidities |
arthritis, mild hypertension, history of cardiac problems in family |
| Policy |
Don't know |
| Comments |
At first I felt as if they were unconcerned about my issues with insurance until I finally was connected with a nurse whose first name was Leslie. She asked me a few questions and promptly approved my surgery. She was extremely helpful and concerned. I recommend that anyone wanting this surgery stay in constant contact with their insurance company to ensure prompt approval. |
| Source |
Sandy B |
