| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/07/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
46.8 |
| MD-supervised programs |
2 (102 weeks) |
| Comorbidities |
History of heart disease. Reduced mobility. Joint pain. |
| Policy |
Must be medically necessary |
| Comments |
Dr. Fisher's office dealt with the
insurance company. |
| Source |
Julie M |
| Insurer Policy |
Aetna (preferred choice) |
| Insurer Status | Approved after first letter (03/13/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
8 |
| Pre-Op BMI |
58.9 |
| Policy |
Don't know |
| Comments |
The only delay I experienced was do to contract negotions at my husbands work. The day after the contract was signed I was approved for surgery. I believe they were waiting to see if they would be insuring us for the next 5 years or not before approval was given. |
| Source |
Pam G |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (04/28/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
51.3 |
| Comorbidities |
Sleep apnea, GERD |
| Policy |
Must be medically necessary |
| Comments |
First letter sent - I have heard that they approve routinely. Will know soon!!
April 28- was approved after first letter with no hassles. I did not deal with my insurance at all my doctors staff did all the work!! Thank you Suzy. |
| Source |
Anna L |
| Insurer Policy |
Aetna (Managed Choice) |
| Insurer Status | Approved after first letter (09/15/98) |
| Surgery Type |
Open RNY |
| Weeks to approval |
9 |
| Pre-Op BMI |
44.7 |
| Comorbidities |
Incontinence, trouble with knees and severe asthma and depression |
| Policy |
Must be medically necessary |
| Comments |
I would have to say that I had a very nice experience with my insurance company. I think the reason behind that was due to the other people who had the surgery prior to me while I worked at Citibank. I guess things have changed since then and that I was truly blessed with how smooth things went for me. |
| Source |
Leasha C |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (3/1/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
GERD, PCOS |
| Policy |
Must be medically necessary |
| Comments |
I have not heard anything from Aetna so far, but from what I have read on here, they seem pretty reasonable.
3/2/02~ APPROVED after first letter. I am so pleased with them. They have been very wonderful. |
| Source |
Steph G |
| Insurer Policy |
Aetna (US Access) |
| Insurer Status | Approved after first letter (02/15/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
72.1 |
| Source |
Carol D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after legal action taken (10/10/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Comorbidities |
GERD,shortness of breath,joint pain, fatique,depression,feet problems,lower back pain,gallbladder st |
| Policy |
Don't know |
| Comments |
I was told they changed their policy July 25th. They now require five years of medically documented morbid obesity and a six month doctor supervised diet in the last two years. I was denied for not being morbily obese for five years. I think all of this is just stall tactics. I am in the process of filling an appeal. |
| Source |
Robin T |
| Insurer Policy |
Aetna (Managed choice) |
| Insurer Status | Approved after first letter (09/21/01) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
49.6 |
| MD-supervised programs |
2 (32 weeks) |
| Comorbidities |
GERD, depression, joint pains |
| Policy |
Must be medically necessary |
| Comments |
073001 so far my dealings with Aetna have been great. I first started this journey in Jan of 2001 and I went to see te only option that I had here in Nev. my first impressions of the dr were ok but I tried doing what was asked of me to do (to the tune of over 500 bucks). When I tried to reschedule appts with him he refused to recontact me or reply to my many emails.So I called to find a out of state dr that they would still cover for the surgery. They were very helpful and have given me a list of over 20 dr's from the Ca and AZ area (my preferrences).All of which are preferred providers!!!!!!!!
092101 I will have to say that aetna has been wonderful so far. They approved me to see an out of state Dr. as if it were within the local network. They have been great.
I was approved with just the letter of medical necessity that was submitted. Love this company. |
| Source |
Tami G |
| Insurer Policy |
Aetna (Prime Heath) |
| Insurer Status | Approved after first letter (07/27/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
66.1 |
| Comorbidities |
Diabetes, sleep apnea, acid rflux, asthma |
| Policy |
Must be medically necessary |
| Comments |
My insurance company was GREAT!!! They approved my surgery 3 days after receiving the letter from the doctor's office. |
| Source |
Sandi K |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after appeal letter (11/2/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
5 |
| Comorbidities |
Arthritis, PCOS, Amenorrhea, Insulin Resistance |
| Policy |
Must be medically necessary |
| Comments |
Aetna has very polite representatives. The only problem I found was that you cannot speak to the Medical Director. I was told that the approval would occur, then I was sent a letter denying the surgery with Dr Owens. There is one doctor in the state of NV that Aetna will approve, and I refuse to go to him. The followup care is too important for me not to want to go to that horrible man. Anyway--after a 12 page appeal letter, copy to Med Director, and copy to my PCP, I finally got approval. They also called my doctor, who gave them what for over the phone. hahaha She's great! Through everything, they still treated me very well. |
| Source |
Jenni B |
| Insurer Policy |
Aetna (USA Access) |
| Insurer Status | Approved after first letter (10/07/01) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
44.1 |
| MD-supervised programs |
2 (32 weeks) |
| Source |
Candi G |
| Insurer Policy |
Aetna (Open Choice PPO) |
| Insurer Status | First letter sent - still waiting (12/12/01) |
| Source |
Tina M |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (01/05/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Comments |
aetna was great to deal with. the doctors office sent in the paperwork and i tried to call aetna to see if they had received the info and they said that i was approved after only three days. the Dr. hadn't been notified yet due to the changing of the office location, but they did call me the same day that i found out. i just didn't think the approval would be this easy. YEAH AETNA!!!!!!!!!!!!!!! |
| Source |
Angel S |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (02/20/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
41.5 |
| MD-supervised programs |
3 (92 weeks) |
| Source |
Ron M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (04/15/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
53.8 |
| MD-supervised programs |
4 (64 weeks) |
| Comorbidities |
I am 200 lb over weight , leaky heart valves, slipped disk, knee cap injuries, can hardly walk, heal |
| Policy |
Must be medically necessary |
| Comments |
Actually once you start to appeal, they instantly want to know why and tell you what exactly is missing or what you need and what can make a difference in now or later if at all.They are not all that hard to work with especially when they see the need is really there and you have done everything they have asked, maybe dates might be a little off, but if you have letters from your own primary as well, and any other doctor that may be treating you bsided your surgeon, they do not care what your surgeon is thinking at this time, they care what you and your regular doctor feel and if it is deemed medically needed and your doctor gives them hell and tells them what else you have been going through and for how many years, they are more likely to listen to him and take his view than they are the surgeons, this is what they expressed to me and what we went for. The letter my sister wrote on behalf of my four children and my husband didn't hurt either.I think they automatically throw up the red stop right away. They think too many people are doing this that can loose it and keep it off just choose not to, therefore they want proof of that not being so.I do believe they respond to persistence as not only I called but so did my sister in California from her home, everyday, two and three times a day, all the way to the top.I would make certain that I have everything before I ever even get started with the surgeons requirements. If you know you have done near all of it except maybe the 6 month diet, then go ahead and get started with that on your primary doctors charts and then start all the needed tests for surgery, that way you have something else to keep you busy at the same time. Constantly keep up with Aetna and there web site. Ask them yourself if they have any changes to the what they go by. They have some people that have had this proceedure and know the red tape personally.Be very honest with how you actually feel , not by what you know is wrong but how you feel, like when you lye down, do you feel this could be it? Let them know, they want to hear you. I was pleased by the nurse and doctor at Aetna that worked out my case. |
| Source |
Renee S |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (08/31/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
48.9 |
| Comorbidities |
diabetes |
| Policy |
Don't know |
| Comments |
once my paper work was completed and forwarded to the insurance company they approved in 2 days, no problem |
| Source |
Gretchen H |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after appeal letter (11/14/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
14 |
| Pre-Op BMI |
42.8 |
| Comorbidities |
Arthritis, Shortness of breath, Incontinence, Edema. |
| Policy |
Must be medically necessary |
| Comments |
Aetna has been horrible! There pre-determination department is unorganized, uneducated, and misleading.
Dr. Ganser's office submitted paperwork the beginning of August 2002. By the end of September Aetna finally admitted they did receive paperwork but, at this time, they could not locate my file. Dr. Ganser had to resubmit the paperwork again to the pre-determination department the end of September.
I was verbally told by Aetna that I was denied benefits on October 4, 2002. I did not meet their criteria -- whatever that may be. As of today, 10/09/02, I have not received a letter from the Medical Director at Aetna explaining why I was denied.
Aetna has always returned phone calls but depending on who you speak to depends on the answers you get.
I recommend persistence, persistence, and more persistence when dealing with Aetna. **********************
*****
*****
*****
*****
UPDATE: I WAS APPROVED AFTER 1ST APPEAL!!!
The only thing I can say is WOW! The Medical Director was impressed by the mounds of paperwork I sent. I provided copies of all the pharmacy reports since 1996 for their review. There was no denying what medications I had taken, etc.
The Grievance and Appeals Office was extremely friendly and helpful. I called every few days and asked if they needed additional paperwork, etc. I was able to speak to a real person who handled my case and they returned phone calls. YEAH!
Aetna does approve! You need to be organized, have all of your documents, the more ammunition the better.
GOOD LUCK to everyone else.
Robin
|
| Source |
Robin H |
| Insurer Policy |
Aetna (AETNA PPO) |
| Insurer Status | Approved after first letter (10/28/02) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
BORDERLINE DIABETIC, BREATING PROBLEMS, PCOS, SWOLLEN LEGS AND ANKLES, BACK PROBLEMS, |
| Policy |
Must be medically necessary |
| Comments |
Well my insurance change there policy on bariatric surgery. After 1/03 now my insurance is requiring 5 years of verfiable weight problem and 6 months of an diet that has had been supervised by an physican. |
| Source |
Ana B |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | First letter sent - still waiting (12/25/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
47.0 |
| Comorbidities |
sleep apnea, arthris, swollen legs, shortness of breath, chest pain and back pain, dail, pcos |
| Policy |
Don't know |
| Comments |
Well it has been now 2 weeks and no answer. I am so anxious that I can't wait it seems like forever. |
| Source |
Ana A |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (04/25/2003) |
| Surgery Type |
Open RNY - distal |
| Policy |
Must be medically necessary |
| Comments |
They gave me the most trouble trying to get the pre-op appointments approved. The doctors I needed to see were not in network so I had to pay cash. But the good news... they approved the surgery in 2 days!!! |
| Source |
Debby H |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (08/28/03) |
| Weeks to approval |
2 |
| Comorbidities |
Sleep Apnea, High Blood Pressure, Hypertension |
| Policy |
Must be medically necessary |
| Comments |
I really didn't deal with them, the girl at my Dr's office did. I think things went pretty fast after everything was submitted. I would recommend that you follow all the requirements in order, so you don't have to do things over. |
| Source |
Dorothy S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (12/12/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
46.3 |
| Source |
Mark T |
| Insurer Policy |
Aetna (managed choice pos) |
| Insurer Status | Approved after appeal letter (11/15/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
52.3 |
| MD-supervised programs |
2 (220 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Aetna is doing their best to get out of covering the surgery. I am appealling their decision. |
| Source |
Patrica S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (1/01) |
| Policy |
Don't know |
| Comments |
I had no problems at all. I would highly recommend Aetna. |
| Source |
Mariana O |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (12/23/04) |
| Weeks to approval |
2 |
| Comorbidities |
joints |
| Policy |
Must be medically necessary |
| Comments |
Aetna was amazing. I was a little concerned and had my arsenal ready (all of the letters and lawyers that I had found on the boards) but it was not necessary.
I had just enough information and was lucky enough to have gone to the dr. over the past five years where unbeknownst to me, they had noted my weight in the chart.
I don't think they stalled me at all, I was approved two weeks after they received my information.
I know that this is not everyone's experience, but all I can recommend is that you have every bit of information you can share with them. I had joined a club, met with a trainer, etc. I photocopied all of that to submit with my letter. |
| Source |
Darci S |
| Insurer Policy |
Aetna (Choice ppo) |
| Insurer Status | Approved after 2nd appeal letter (02/22/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
60 |
| Pre-Op BMI |
50.5 |
| Comorbidities |
Sleep apnea, hip pain, knee pain, hypertension, GERD |
| Policy |
Must be medically necessary |
| Comments |
They are very difficult. It took almost 2 years to get approval, because they changed their policy. If I had it to do over again, I would ask for their policy in writing up front to avoid the hassles I went through. They definately need to be followed very carefully..attentively to get this through their process. I think they are great at stallling, and it took threats of filing a Department of Insurance complaint and a threat of a law suit to get the approval. I strongly suggest a personal journal of everything you do to get approved as evidence in case you need it. |
| Source |
Connie H |
| Insurer Policy |
Aetna (Open access HMO) |
| Insurer Status | Approved after first letter (12/23/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Comorbidities |
sleep apnea, GERD |
| Policy |
Must be medically necessary |
| Comments |
It took a while to get the correct information from them. I began in March with the 6 month supervised diet where I actually gained weight. Then once I received the correct information everything was submitted and within 2 weeks I was approved. |
| Source |
Christina V |
| Insurer Policy |
aetna (ppo) |
| Insurer Status | First letter sent - still waiting (12/02/05) |
| Comorbidities |
Chronic skin conditions, Depression, GERD, Shortness of breath, Sleep apnea |
| Source |
Tammy S |
| Insurer Policy |
Aetna (choice first EPO) |
| Insurer Status | Approved after first letter (01/16/06) |
| Surgery Type |
Laparoscopic Lap Band |
| MD-supervised programs |
2 (48 weeks) |
| Policy |
Must be medically necessary |
| Source |
Robin S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/02/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Policy |
Must be medically necessary |
| Comments |
Aetna was a little slow in responding so I actually missed my first scheduled date (missed it by 2 days). They also do not cover lap band unless you are medically unable to have RNY (for example .. have colitis and can't have RNY). The coverage is AMAZING. The entire thing has cost me less than $500! They also have a representative that gets your case and calls you pre-op, two days post-op, 2 weeks post-op, then every three months and at one year. They also provide a 24 hour nurses hotline if you need advice on anything.
Edited on 7/17/07: ** I had a lap-band revision last week and they approved my revision in one day. I had to pay $250 for the entire thing .. the hospital, doctors, tests, etc. It was an emergency revision and I was admitted through the ER. I paid $100 in the ER and the other $150 upon discharge. |
| Source |
Farrah K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10-25-07) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
36.8 |
| MD-supervised programs |
2 (12 weeks) |
| Comorbidities |
diabetes |
| Policy |
Must be medically necessary |
| Comments |
They were great! I didn't have any problem and was approved in less than 1 day. My cost is $250.00.... |
| Source |
Laurie P |
| Insurer Policy |
Aetna (POS II) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
2 |
| Policy |
Must be medically necessary |
| Comments |
The insurance Company was great. All I did was after my insurance kicked in I called them to see if they would cover this and they told me I would if I completed all of the requirements like going to the dr once a month for 6 months. I have been very happy with them. |
| Source |
Viki B |
| Insurer Policy |
Aetna (managed choice ) |
| Insurer Status | Approved after first letter (5/29/08) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
41.4 |
| Comorbidities |
metabolic syndrome |
| Policy |
Must be medically necessary |
| Source |
Erica W |
| Aetna POS |
|---|
| Insurer Policy |
Aetna POS |
| Insurer Status | Approved after first letter (10/20/2008) |
| Surgery Type |
Laparoscopic RNY |
| Policy |
Don't know |
| Source |
Jennifer L |
| AGA-American Group Administrators |
|---|
| Insurer Policy |
AGA-American Group Administrators (Nevada Dental Association) |
| Insurer Status | Approved after first letter (02/25/04) |
| Weeks to approval |
4 |
| Policy |
Must be medically necessary |
| Comments |
The insurance person at my surgeon's office did have to call quite a few times. The insurance company stated they had to wait to have an office manager at the insurance company approve it. I definitely think they stalled on it for a couple of weeks. |
| Source |
Laura P |
| American Administrators |
|---|
| Insurer Policy |
American Administrators |
| Insurer Status | Approved after first letter (10/18/99) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
63.5 |
| Source |
Renee G |
| American Benefit Plan |
|---|
| Insurer Policy |
American Benefit Plan (Self Funded / County) |
| Insurer Status | Approved after first letter (04/06/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
43.9 |
| Comorbidities |
I have been diagnosed as being morbidly obese. Fortunatley, I am still very healthy |
| Policy |
Must be medically necessary |
| Comments |
4/12/00 After all my paperword was submitted, it only took about 6 hours for MCC to call and give me the great news of my approval. Thank you Lydia!
Managed Care Consultants (MCC) is the parent company of American Benefit Plan Administrators. MCC makes the determination if the surgery is deemed medically necessary. They do not practice preventative medicine. What I mean from this, they want you to have serious medical problems. They prefer that you have a disease rather than work to prevent the disease from occurring. According to Dr. Fisher, they have only approved one of his patients. I am, and have been fighting with them for approval. It is an ongoing battle, one I fear I will not win. Therefore I am looking in to obtaining legal assistance or even paying for the surgery myself. |
| Source |
Katie L |
| Insurer Policy |
American Benefit Plan (Managed Care Inc.) |
| Insurer Status | Approved after first letter (05/29/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
43.9 |
| MD-supervised programs |
4 (61 weeks) |
| Source |
Dina J |
| American Medical Security |
|---|
| Insurer Policy |
American Medical Security (PPO) |
| Insurer Status | Denied after appeal letter (02/14/01) |
| Surgery Type |
Open RNY - proximal |
| Policy |
Written exclusion policy |
| Comments |
Denied after initial request due to exclusion policy.
I will be paying cash for the surgery. |
| Source |
Arlene J |
| Anthem |
|---|
| Insurer Policy |
Anthem (ppo) |
| Insurer Status | Approved after first letter (06/14/03) |
| Source |
Dayna C |
| Insurer Policy |
Anthem |
| Insurer Status | Approved after first letter (12/29/03) |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Marissa P |
| Insurer Policy |
Anthem |
| Insurer Status | Denied after first letter |
| Source |
Stacey H |
| Anthem BCBS |
|---|
| Insurer Policy |
Anthem BCBS (PPO) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
1 0 |
| Source |
Shannon C |
| Insurer Policy |
Anthem BCBS |
| Insurer Status | Approved after first letter (8-13-08) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
51.8 |
| Policy |
Don't know |
| Comments |
I was given my date exactly 2 weeks before my surgery was scheduled and was all approved 6 days before surgery so I can not complain. They gave me no issues and were fast and attentive. |
| Source |
Carrissa D |
| Anthem Blue Cross |
|---|
| Insurer Policy |
Anthem Blue Cross |
| Insurer Status | Approved after first letter (10/12/03) |
| Surgery Type |
Laparoscopic RNY |
| Source |
Rhonda W |
| Insurer Policy |
Anthem Blue Cross |
| Insurer Status | Approved after first letter (08/07/06) |
| Weeks to approval |
1 |
| Comorbidities |
Hypertension, Depression, Hypercholesterolemia, Shortness of breath |
| Policy |
Must be medically necessary |
| Comments |
The approval process took just a couple of days. The only problem (which is my problem)is that they would not approve the Lap Band, which is what I wanted, but they approved the more invasive surgery. This was due to my BMI being so high. |
| Source |
Maryellen B |
| Anthem Blue Cross PPO Nevada Anth. |
|---|
| Insurer Policy |
Anthem Blue Cross PPO Nevada Anth. (Anthem Blue Cross PPO Nevada A) |
| Insurer Status | Approved after first letter (06/05/06) |
| Comorbidities |
GERD, Hypercholesterolemia |
| Policy |
Don't know |
| Source |
Scott L |
| Anthem Blue Cross/Blue Shield |
|---|
| Insurer Policy |
Anthem Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (5/2008) |
| Surgery Type |
Laparoscopic Lap Band |
| Comorbidities |
Sleep apnea, diabeties |
| Policy |
Don't know |
| Comments |
My insurance responded within one day of the pre-authorization from my surgery group. No problems at all. They have a great plan worked out with my insurance company and I didn't have a lot of out of pocket expenses. |
| Source |
Beverly B |
| applied for disability |
|---|
| Insurer Policy |
applied for disability |
| Insurer Status | First letter sent - still waiting (09/18/02) |
| Source |
Roberta B |
| atena |
|---|
| Insurer Policy |
atena (ppo) |
| Insurer Status | Approved after first letter (11/11/03) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
1 (29 weeks) |
| Source |
Edward T |
