| Blue Cross |
|---|
| Insurer Policy |
Blue Cross |
| Insurer Status | Approved after first letter (10/27/05) |
| Source |
Isabel L |
| Blue Cross Blue Sheild |
|---|
| Insurer Policy |
Blue Cross Blue Sheild (Anthem) |
| Insurer Status | Approved after first letter (08/04/05) |
| Surgery Type |
Laparoscopic Lap Band |
| Pre-Op BMI |
45.1 |
| MD-supervised programs |
2 (64 weeks) |
| Policy |
Must be medically necessary |
| Source |
A N |
| Horizon Blue Cross |
|---|
| Insurer Policy |
Horizon Blue Cross (HMO) |
| Insurer Status | Approved after first letter (04/05/05) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
45.0 |
| Source |
Lynn D |
| 1199 National Benefit Fund |
|---|
| Insurer Policy |
1199 National Benefit Fund ( Hospital & Health) |
| Insurer Status | Approved after first letter (09/05/03) |
| Surgery Type |
Open RNY |
| Source |
Juan E |
| 464A |
|---|
| Insurer Policy |
464A (Local464A) |
| Insurer Status | (07/31/04) |
| Surgery Type |
Open VBG |
| Comorbidities |
very bad diabetes, numbnes in my legs and some of my toes and can't hardly walk as much, |
| Policy |
Written exclusion policy |
| Comments |
As for everybody that have problem with their insurance like I do keep on fighting don't give up, let them give up and give it to you. Idid They wasn't going to pay anything now they going to pay the hospital,that' okay it works for me. |
| Source |
Gladys R |
| St. Barnabas Health Care System |
|---|
| Insurer Policy |
St. Barnabas Health Care System (Exclusive) |
| Insurer Status | Approved after first letter (01/27/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
59.7 |
| Comorbidities |
Sleep Apnea, GERD, arthritis |
| Policy |
Must be medically necessary |
| Comments |
I think the Saint Barnabas Health Plan System is WONDERFUL, they care about the patients they insure. |
| Source |
Julie G |
| A/USHC |
|---|
| Insurer Policy |
A/USHC (QPOS) |
| Insurer Status | Approved after first letter (08/02/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
66.2 |
| Comorbidities |
Hypertension |
| Policy |
Must be medically necessary |
| Source |
Carrie V |
| Access Medical |
|---|
| Insurer Policy |
Access Medical (ppo) |
| Insurer Status | Approved after first letter (12/15/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
65.2 |
| Policy |
Must be medically necessary |
| Source |
David B |
| Insurer Policy |
Access Medical (PPO) |
| Insurer Status | Approved after first letter (03/31/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Comorbidities |
FAMILY HISTORY OF HEART, BACK-KNEE PAIN |
| Policy |
Don't know |
| Comments |
THEY APPROVED MY SURGERY IMMEDIATELY. UNFORTUNATELY DR. ANDREI IS OUT OF NETWORK AND I WILL HAVE TO PAY FOR SOME OF THE SURGERY. I WANTED TO STAY WITH A SURGEON WHO I HAVE FAITH IN. MY BEST FRIEND HAD SURGERY LAST FEBRUARY WITH DR. ANDREI AND SHE LOVES HIM |
| Source |
Barby M |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (09/05/2003) |
| Surgery Type |
Laparoscopic Lap Band |
| Comments |
Approved after 4 weeks. No problems, no questions. I'm very pleased with their response to my situatuion. Thanks, Horizon Direct Access! |
| Source |
Lenny D |
| Insurer Policy |
Access Medical (DIRCET ACESS) |
| Insurer Status | Approved after first letter (09/01/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
58.4 |
| Policy |
Don't know |
| Source |
Tasha R |
| Aenta |
|---|
| Insurer Policy |
Aenta |
| Insurer Status | Approved after first letter (05/26/06) |
| Surgery Type |
Laparoscopic Lap Band |
| Comorbidities |
Sleep apnea, Arthritis |
| Source |
V V |
| Aethna |
|---|
| Insurer Policy |
Aethna |
| Insurer Status | Denied after first letter (10/12/01) |
| Source |
Ana R |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Exclusion |
| Source |
Nancy C |
| Insurer Policy |
Aetna (Quality Point of Service) |
| Insurer Status | Approved |
| Source |
Karen P |
| Insurer Policy |
Aetna (ppo- I Private Pay) |
| Insurer Status | Approved |
| Surgery Type |
RNY - distal |
| Pre-Op BMI |
54.7 |
| Comments |
Aetna Us. Healthcare- Approved within a couple of months first time around. I'd consider them excellent for approving WLS Surgery. Their policy says will cover treament for weight loss if considered "Morbidly Obese" by your Doctor. |
| Source |
Gwen A |
| Insurer Policy |
Aetna |
| Insurer Status | Exclusion |
| Comments |
i have not tried yet! |
| Source |
Nicole A |
| Insurer Policy |
Aetna |
| Insurer Status | Exclusion |
| Comments |
HAD TROUBLE WITH THEM,THEY CLAIMED THE SURGERY WAS COSMETIC. APPEALED,FINALLY THEY AGREED AFTER A CONGRESSMAN CALLED THEM. |
| Source |
Nina R |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (05/15/04) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
47.0 |
| MD-supervised programs |
1 (20 weeks) |
| Comorbidities |
hypertention |
| Policy |
Don't know |
| Source |
Jim L |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/05/00) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
45.9 |
| Comorbidities |
GERD |
| Comments |
AETNA US HEALTHCARE WAS WONDERFUL I NEVER EVEN SPOKE TO THEM THEY APPROVED ME IN TEN MINUTES. |
| Source |
Debbie B |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (10/21/99) |
| Surgery Type |
Laparoscopic Other |
| Pre-Op BMI |
59.9 |
| Comments |
My employer switched healthcare providers from AEtna POS to CIGNA PPA effective 1/1/00.My surgery was 1/4/00. CIGNA had to accept the pre-cert from AEtna but they've faught the bills ever since.It takes someone from my company calling them with each set of bills to get them approved.So far so good though.They've paid everything. I'm working on my 4 month follow-up bills before I get hit with the 6 month follow-ups.
My advise to everyone-get everything in writing, keep good notes of who you spoke to and put everything together in one bindr so you don't have to search!!!! |
| Source |
Irene H |
| Insurer Policy |
Aetna (PATRIOT V) |
| Insurer Status | Approved after first letter (07/30/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
49.6 |
| MD-supervised programs |
1 0 |
| Policy |
Don't know |
| Comments |
My insurance was real fast. The office nurse told me on my first appointment that they had to write a note to the insurance and wait for an answer. 8 days later I had a surgery date and the insurance would cover it. |
| Source |
Amy H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/25/99) |
| Surgery Type |
Laparoscopic VBG |
| Weeks to approval |
1 |
| Comorbidities |
diabetes, knee and back pain, foot problems, asthma |
| Comments |
This is a wonderful insurance company. I highly recommend them. |
| Source |
Marilyn P |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/06/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
52.6 |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
NO COMORBIDITIES |
| Policy |
Must be medically necessary |
| Comments |
IT HAS ACTUALLY BEEN ALMOST 7 WEEKS SINCE THE FIRST LETTER WAS SENT TO THEM BUT THEY SAID IT WAS SENT TO THE WRONG ADDRESS AND IT HAD TO BE SENT OUT A SECOND TIME TO A NEW ADDRESS...FROM THE SECOND TIME TO APPROVAL WAS THREE WEEKS. I CALLED AFTER TWO WEEKS EVERY TWO DAYS AND INQUIRED ABOUT THE STATUS OF MY REQUEST. I FOUND OUT IT WAS IN REVIEW 5 DAYS BEFORE IT WAS APPROVED. I THINK IF I HADNT CALED THEM SO MUCH I WOULD STILL BE WAITING! |
| Source |
Gina R |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (02/21/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
40.5 |
| MD-supervised programs |
2 (48 weeks) |
| Policy |
Must be medically necessary |
| Comments |
Couldn't have been easier, approved in 10 days and I was borderline with a BMI of 41. |
| Source |
Dorothy A |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (11/21/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Comments |
Aetna has been wonderful so far. I was approved very quickly. |
| Source |
Karen G |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (02/16/00) |
| Surgery Type |
Open RNY - proximal |
| Source |
Nancy G. W |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (12/28/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
51.6 |
| Policy |
Must be medically necessary |
| Source |
Wendy B |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (02/28/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
55.4 |
| Comorbidities |
early stage arthritis and back pain |
| Policy |
Don't know |
| Comments |
Once the Dr's office made the call to the insurance company, I was approved the same day without any problems. They did not cover one of my psychological evaluations required for preadmissions but that was a small price to pay for the ease and convenience of the approval for surgery. |
| Source |
Tracy R |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (09/15/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
49.2 |
| MD-supervised programs |
5 (64 weeks) |
| Comorbidities |
sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
They stalled alittle but I called eveyday until I got my aproval. |
| Source |
Michelle R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/18/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
66.8 |
| MD-supervised programs |
1 (32 weeks) |
| Comorbidities |
Sleep apnea |
| Policy |
Don't know |
| Source |
Amanda P |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (7/26/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
42.9 |
| MD-supervised programs |
3 (93 weeks) |
| Policy |
Don't know |
| Comments |
I would recommend Aetna US healthcare to
ANYONE. They are the BEST. This surgery
means the world to me bacause it is giving
me my life back and they are helping with
that. They approved me in one week. I have
spoken with others that were approved in
less time then that by this company. |
| Source |
Wendy B |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (09/26/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
56.3 |
| Source |
Jackie C |
| Insurer Policy |
Aetna (NJ Small Group Plan - HMO) |
| Insurer Status | Approved after first letter (05/25/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
47.1 |
| MD-supervised programs |
2 (8 weeks) |
| Policy |
Must be medically necessary |
| Comments |
I didn't deal with them at all. My clinic faxed a letter on wednesday and they approved it that friday. awwsssooommmee |
| Source |
Alison B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/01/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
42.3 |
| MD-supervised programs |
1 (20 weeks) |
| Comorbidities |
sleep apnea, arthritis |
| Policy |
Must be medically necessary |
| Comments |
I didn't have to deal with them at all-the office did. I was approved after the first letter. |
| Source |
Christina W |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after appeal letter (02/01/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
12 |
| Pre-Op BMI |
52.6 |
| Comorbidities |
sleep apnea, joint pain, vericose veins, incontenence, reflux |
| Policy |
Must be medically necessary |
| Comments |
Criteria is at least 100lbs over weight, and co-morbitities. They do stall, so you must continue to call and bug them about your approval. If you don't hear anything within 2 weeks from the time your doctor sends in your predetermination than make sure you call and ask how long this should take. Don't give up, if they deny you make sure you appeal, and then appeal again. Unless your policy states that they don't cover obesity you should beable to get an approval. |
| Source |
Dianna G |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (07/18/00) |
| Comorbidities |
I HAVE STENOSIS ON LOWER BACK. ALSO BEGINNING TO HAVE PROBLEMS WITH KNEE'S IE...WALKING UP/DOWN STA |
| Policy |
Must be medically necessary |
| Comments |
DEALING WITH AETNA HA BEEN STRESSFUL.
I CALLED ON JULY 14TH, THEY TOLD ME I WAS APPROVED.
I CALLED AGAIN ON JULY 17TH,2000 SIMPLY BECAUSE THIS IS AETNA. I WAS TOLD IT WAS PENDING AND THEY NEEDED MORE INFORMATION.
THERE NOTHING IN THERE SYSTEM THAT SAID I WAS APRROVED.
THE INFORMATION NEEDED WAS SENT IN FROM MY PCP AND MY SUREGON, BUT AETNA COMPUTER SUSTEM WASN'T SHOWING THAT.
MY PREVIOUS INSURANCE WAS PRU-CARE AND I NEVER HAD A PROBLEM, AETNA HAS BEEN SLOW, DIFFICULT AND AT TIMES RUDE.
I WILL CALL THEM EVERYDAY UNTIL THEY REPSOND WILL AN ANSWER AND GO ON FROM THERE.
I HOPE SOMETHING IN THE FUTURE CHANGES WITH THESE INSURANCE COMPANIES, BECAUSE THIS VERY SCARY!!! |
| Source |
Frank S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/21/00) |
| Surgery Type |
Open RNY - proximal |
| Source |
Jan P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/26/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
42.1 |
| Comments |
I honestly can't say what it was like to deal with the insurance company because Dr. Abkin's nurse practitioner handled everything for me! |
| Source |
Christina C |
| Insurer Policy |
Aetna (Patriot XV QPOS) |
| Insurer Status | Approved after first letter (9/13/00) |
| Surgery Type |
VBG |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.8 |
| MD-supervised programs |
1 (16 weeks) |
| Policy |
Must be medically necessary |
| Source |
Kathleen D |
| Insurer Policy |
Aetna (NJS Patriot V QPOS) |
| Insurer Status | Approved after first letter (02/28/02) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Pre-Op BMI |
68.2 |
| MD-supervised programs |
5 (140 weeks) |
| Comorbidities |
diabetes, hypertension,osteoarthritis, depression, high cholesterol, asthma, stress incontnence |
| Policy |
Must be medically necessary |
| Comments |
Aetna US Healthcare is an excellent insurance company for approval of gastric bypass surgery. They will approve Roux en Y gastric bypass for a patient over 40 BMI, or 35-40 BMI with co-morbidities. There policies are posted online at http://www.aetnaushc.com
If you have Aetna USHealthcare and meet the requirements you will have no problem getting approval for this surgery. |
| Source |
Christine W |
| Insurer Policy |
Aetna (qpos) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
4 |
| Pre-Op BMI |
39.5 |
| Comorbidities |
hypertension, high cholest. |
| Policy |
Must be medically necessary |
| Comments |
they are how can I say, like the porch lights on and no one is home. I is very annoying to keep repeating yourself, but it works. I really think persistence helps I called every 2 days. Get your doctor involved. I annoyed him also, so I think he pushed them to get me off his back. |
| Source |
Mary N |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (08/29/00) |
| Weeks to approval |
9 |
| Comorbidities |
all of above |
| Policy |
Must be medically necessary |
| Source |
Lisa V |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/20/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
52.8 |
| Comorbidities |
Co-morbiditie, Sleep apnea, arthritis, Reflux, |
| Policy |
Must be medically necessary |
| Comments |
cross your fingers |
| Source |
Richard M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/09/00) |
| Surgery Type |
Open Other |
| Weeks to approval |
1 |
| Pre-Op BMI |
54.9 |
| Comorbidities |
back pain, joint pain, slight sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
I LOVE THEM. NO PROBLEMS WHATSOEVER |
| Source |
Antoinette H |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (09/24/00) |
| Weeks to approval |
1 |
| MD-supervised programs |
4 (80 weeks) |
| Comorbidities |
knee pain and lower back pain |
| Policy |
Must be medically necessary |
| Comments |
Well, I didn't have to do a thing. My Dr.'s office handled everything and I was approved in less than 2 weeks.
I would recommend Aetna USHC to anyone that is having trouble with their insurance company because as long as it is medically necessary they will cover your surgery. It's that simple. No kidding!! I am very pleased with them. They are great.. |
| Source |
Mary Ann |
| Insurer Policy |
Aetna (Value Plus) |
| Insurer Status | Approved after first letter (10/18/00) |
| MD-supervised programs |
1 0 |
| Source |
Ingerlise G |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (March 2000) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.3 |
| Source |
Mary M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/27/00) |
| Surgery Type |
RNY |
| MD-supervised programs |
1 (2 weeks) |
| Comments |
MY DR OFFICE HANDLED ALL INS.REQUEST I WAS APPROVED AFTER 2 IN A HALF WEEKS SO THEY WERE GREAT! |
| Source |
Tracy D |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (10/29/00) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
2 (29 weeks) |
| Source |
Roxanne S |
