| Ace Hardware |
|---|
| Insurer Policy |
Ace Hardware (Pacific Mutual, then Humana) |
| Insurer Status | (04/28/01) |
| Surgery Type |
RNY |
| Weeks to approval |
1 |
| MD-supervised programs |
2 (106 weeks) |
| Comorbidities |
Sleep apnea, arthiritis, hypertension, |
| Policy |
Must be medically necessary |
| Comments |
They cover this procedure and only need a call from the doctor. I had to change Ins to Humana, but they approved ASAP on medical necessary procedure, unfortunatly,hospital is not on their list, so I pay more $. |
| Source |
Suzy A |
| Admin One |
|---|
| Insurer Policy |
Admin One (Preferred Community Choice) |
| Insurer Status | Approved after first letter (July 2002) |
| Surgery Type |
Open RNY |
| Weeks to approval |
16 |
| Pre-Op BMI |
50.3 |
| Comorbidities |
None |
| Policy |
Don't know |
| Comments |
The reason it took so long was due to the fact that at the time of my first appointment (March 2002) I had only worked for the company for a few months. They had to do a pre-existing condition investigation before approval.
They were very helpful and answered all of my questions that I had.
Just continue to follow-up and make phone calls once or twice per week. |
| Source |
Scott O |
| Insurer Policy |
Admin One (Med Core One) |
| Insurer Status | Denied after first letter (08/28/05) |
| Comorbidities |
I have Sleep Apnea,Gerd, arthritis,high blood pressure and fluid retention |
| Policy |
Don't know |
| Comments |
Me and a co-worker started this together in June. The insurance company said my doctors report showed thyroid problems and my doctor said they don't, so been tested 3 times for the insurance company,they are finally satisfied with the results.Then they wanted the pysic eval & sleep study done. Done that. Yesterday they sent my friend an approval letter and told me they would have an answer today. Well they called both of us today and told us there had been a mistake and they were looking at last years book and that now they do not pay for the surgery. So we are going to find out if there is anything we can do about it. |
| Source |
Debbie S |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/17/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Source |
Missy |
| Insurer Policy |
Aetna (Open Choice-PPO) |
| Insurer Status | Approved after first letter (05\31\00) |
| Surgery Type |
Open VBG |
| Weeks to approval |
6 |
| MD-supervised programs |
1 (4 weeks) |
| Comorbidities |
No Co-Morbities |
| Policy |
Must be medically necessary |
| Comments |
They were very nice every time I called. Which was about 2 times a week for 6 weeks. They will take the entire 6 weeks to think things over but are very fair. You only have to be 100# overweight to qualify. No-Comorbities required. I called the insurance company on 5/31 and was told there was no answer but then my surgeon called and said I was approved. I suggest keeping in touch with your surgeon. Or you may really be the last to know. |
| Source |
Genevieve T |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (03/06/00) |
| Surgery Type |
Open RNY |
| Comorbidities |
hypertension and heart problems |
| Policy |
Must be medically necessary |
| Source |
Lisa S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (07/23/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
39.8 |
| Source |
Glenna S |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after appeal letter (11/30/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
46.8 |
| Comorbidities |
hypertension,tachycardia,hyperlipidemia |
| Policy |
Must be medically necessary |
| Comments |
My experience with this insurance company has been tough at times i think the reason they denied me the first time was just to see if i would come back i didnt give up and my persistance paid off i am approved yeah! I recommend caling back often and when you get a person that listens stick with them. |
| Source |
Mandy H |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | First letter sent - still waiting (08/23/00) |
| Source |
Melody S |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (11/26/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
56.1 |
| Comorbidities |
Diabetes, high cholesterol, sleep apnea, arthritis |
| Policy |
Must be medically necessary |
| Comments |
It was frustrating at times of course, but hey, they paid for everything! They didn't stall. They were wanting me to have the surgery!!
To be very prepared ahead of time. Have your physicians 100% support for this proceedure. |
| Source |
Michelle J |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (11/16/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
50.0 |
| MD-supervised programs |
1 (8 weeks) |
| Policy |
Must be medically necessary |
| Comments |
They were very helpful, I called several times during the waiting process. Not much stalling, approved after 3 weeks during the Christmas/New Year's holiday; I expected a longer wait.
Must meet criteria: 100 lbs or more overweight, BMI of 40 or more, must have documented history of failed diets.
I wrote an extensive letter listing my diet failure for my surgeon to send in with his letter, I feel this helped the process. If you'd like a copy of my letter, email me at BasketAndi@aol.com |
| Source |
Andrea P |
| Insurer Policy |
Aetna (OPEN CHOICE) |
| Insurer Status | Approved after first letter (5/20/02) |
| Surgery Type |
Open Revision |
| Weeks to approval |
2 |
| MD-supervised programs |
2 (58 weeks) |
| Comorbidities |
high blood pressure |
| Policy |
Must be medically necessary |
| Comments |
Aetna was great! They originally called the doctor's office and wanted a doctor-documented weight loss history. I only had a letter from the doctor I received phen/fen from, but I had also sent along a three-page letter I had written about my life and struggle with obesity. I asked Dr. Jett's office to re-fax that letter, thinking maybe the person who was actually making the decision didn't get my original letter. About three days later, I got my approval call. I think being as detailed as you can about your history and how obesity affects your life is the biggest help of all. |
| Source |
Kristi K |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/12/2001) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
58.3 |
| MD-supervised programs |
2 (65 weeks) |
| Comorbidities |
Sleep Apnea, Hypertension, Gerd, Back ,leg and knee pain , shortness of breath, weak bladder |
| Policy |
Must be medically necessary |
| Comments |
When I called they were very friendly and told me what to gather up in order for them to determine if it was medically necessary and also Darrell at Dr. Pearce's office told us what to ask. |
| Source |
Stacy W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (04/05/02) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
3 (188 weeks) |
| Comorbidities |
Sleep anea, hypertension, short of breath & close to high blood pressure. |
| Comments |
My surgeons office sent a letter and I was denied in two weeks. They are requesting medical records proving that I have been at battle with the bulge for more than 5 years. I got all that information and mailed it off with a letter pleading with them. They can take up to 30 days so I am just waiting. I call twice a week to find out if they have an answer for me. I am getting a little worried but I keep telling myself to be patient.
4/26/02
Oh happy day! I got a call today and am approved after appealing and sending all my medical records. I guess they just needed to make sure I really needed this surgery and was not playing with them. :) |
| Source |
Kelli H |
| Insurer Policy |
Aetna (n/a) |
| Insurer Status | Approved after first letter (01/21/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
39.7 |
| MD-supervised programs |
1 0 |
| Source |
Vicki G |
| Insurer Policy |
Aetna (Citizen Plan) |
| Insurer Status | Approved after appeal letter (02/08/01) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
2 (60 weeks) |
| Source |
Maria M |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (02/17/01) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
2 (52 weeks) |
| Policy |
Don't know |
| Source |
Debbie C |
| Insurer Policy |
Aetna (pos) |
| Insurer Status | Approved after appeal letter (10/25/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
19 |
| Pre-Op BMI |
53.1 |
| Comorbidities |
Sleep apnea , type2 diabetes, hypertension,cantwipemyownassitis,cantputonmysoxitis |
| Policy |
Must be medically necessary |
| Comments |
They denied me after 3 months of countless calls to check progress and getting lots of different answers.I don't think the ins. co. was stalling.Just very strict in a process they were unwilling to share the rules of with me.They said Dr.Gorospe's office should have instructed me but they were VERY busy and did not help me with the process except when I directed them.The ins. co. said they requested more in depth records of past dr. supervised weight loss, a number of times.No one told me about that. Finally,I got the message across and was denied. I then sent a scathing appeal letter,and a history and was approved.I understand how busy the dr.'s office is but they should have called me ONE of the times the info was requested.They were very helpful as far as helping me do what I found out I needed to do.
They did not respond to my persistance.I was only able to find out the problem and get it fixed on my own.
Give lots of documentation of prior weightloss history up front. |
| Source |
Robert K |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/07/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
41.6 |
| Comorbidities |
Only criteria is over 40 BMI, or over 35 with co-morbidities |
| Policy |
Must be medically necessary |
| Comments |
The office staff is very helpful, always available by toll-free phone and very quick on getting insurance approvals.
They have an interactive web-site which speeds things up considerably. |
| Source |
Marla H |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (06/05/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
48.6 |
| Comorbidities |
Diabetes, Hypertension, Hypothyroidism |
| Policy |
Must be medically necessary |
| Source |
DAnn V |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (05/27/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
53.5 |
| Comorbidities |
sleep apnea, hypertension |
| Policy |
Must be medically necessary |
| Comments |
I thought that my insurance company was FANTASTIC! They did not stall with me whatsoever. I feel that yes they to respond to persistence. I feel that if you find someone at the insurance company that you can deal with directly and get their extension, fax number and name, and establish a relationship with you, you will do wonders in getting approved. |
| Source |
Donna S |
| Insurer Policy |
Aetna (unavailable) |
| Insurer Status | First letter sent - still waiting (05/28/01) |
| MD-supervised programs |
1 (20 weeks) |
| Policy |
Don't know |
| Comments |
they have been really rude, almost robotic at times. I have yet to find someone who will really try to help me. They tell me that they don't have any record of recieving my letter from Dr.G, but I think they are just stalling or something. One of the girls at the office is going to send another letter out, and if they say they hav'nt recieved it this time, we are going to send it certified! My consult with Dr.G. was May 16th, plenty of time for them to have recieved his letter. Aetna U.S. Healthcare--if anyone out their knows what they are like to get responses from, please let me know. thanks so much, TERI C.
6/10/01 Just found out that my letter was sent to the wrong place. The letter was sent to the address on the in. card, and come to find out,should of been sent to a co. in Dallas. Who knew??? I called the pre-cert. number on my card, they connected me to a voice mail and I left a message. They called me back in about 24 hours and were very helpful. Said they were with a co.called B.B.C. I never heard of them. Said I should know something in about 8 to 10 working days. I pray for good news. I hope this has helped someone who has this in. co. and has run into a snag as I had. good-luck to all... teri c.
p.s. This is a Aetna Co. I don't know what the initials BBC stand for.
|
| Source |
Teri C |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (06/18/01) |
| Source |
Kimber S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (10/24/01) |
| Policy |
Must be medically necessary |
| Comments |
Dealing with these people has been a nightmare. My first letter was sent three weeks ago and they still have not received it. I have tried to get my surgeon to fax a letter but this has been like pulling teeth. Their office is so busy that they have no time to help the people who need extra help with the insurance company. It seems like they are getting too busy to help anyone other than the people already approved. I am so frustrated right now. I would rather just quit this then be let down. |
| Source |
Sallie V |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Denied after first letter (12-14-01) |
| Surgery Type |
Laparoscopic VBG |
| Pre-Op BMI |
44.5 |
| Comorbidities |
Arthritis,back pain,sleep apnea,fatty liver,ankle problems |
| Policy |
Must be medically necessary |
| Comments |
Went to surgeons office on 10/26/01 and they finally faxed my paperwork on 11/02/01. I called the insurance company on 11/01/01 and spoke to a nice gentleman there, who is thinking about having the surgery done. He was really easy to talk to, so got his name.
He told me once the paperwork gets in the right hands, it takes 48 hours to be approved or denied, and to call back next week.
Im with aetna healthcare hmo.
11/6
Received letter from my surgeons office with a letter from my insurance company stating they want documented doctors diets. OH BOY!!!
Ive had three supervised doctors diets in the last 5 years. Two doctors we found out conviently lost my medcial records!! The other doctor was my previous pcp and the only thing that was probably recorded was my weight loss, due to the fact my insurance company at the time wouldnt approve a supervised diet. Im now waiting on the insurance companies decision..
12/07
DENIED DUE TO NOT ENOUGH DOCUMENTATION OF DOCTOR AUTHORIZED DIETS, SINCE TWO OUT OF THE THREE DOCTORS IVE BEEN ON DIETS WITH THE LAST 6 YEARS CONVIENTLY LOST MY MEDICAL RECORDS. IM GOING TO APPEAL AND GO ON ANOTHER DOCTOR AUTHORIZED DIET FOR THREE MONTHS AND SEE IF THEYLL APPROVE ME AT THAT TIME IF THEY DENY MY APPEAL.. |
| Source |
Shauna S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/26/01) |
| Surgery Type |
Open RNY |
| Source |
Brenda |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (12/15/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
8 |
| Pre-Op BMI |
44.4 |
| MD-supervised programs |
5 (157 weeks) |
| Comorbidities |
GERD, Lupus, Pseudo Tumor Ceribri |
| Policy |
Must be medically necessary |
| Comments |
It was ok. I think this company is going out of business though |
| Source |
Patricia S |
| Insurer Policy |
Aetna (managed choice) |
| Insurer Status | Approved after appeal letter (6/7/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
14 |
| Comorbidities |
diabetes type 2, hypertension, left ventricular hypertrophy, arthritis, asthma, thyroid condition, d |
| Policy |
Must be medically necessary |
| Comments |
They were pretty easy to deal with. It must be medically necessary and you must show that you have been overweight 100 lbs for at least 5 years and been unsuccessful with diets in the past. I received a denial letter after the 1st request telling me we didn't show 5 yrs of morbid obesity. The insurance company told my surgeon's office that if I would do 6 months of strict diet w/ specific clinical notes then they would most likely approve me due to my co-morbids. But they didn't know that we forgot to submit all of the medical records that we has gathered from my doctors over the years. I sent in an appeal letter with all the medical records going back to 1990 showing I have been at least 100 lbs overweight along with a long letter from myself, another letter from my primary care, my surgeon, my cardiologist and the diabetes center and was approved. I believe they would have approved me on the 1st request if we had turned in all the information correctly. |
| Source |
Nadine D |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (06/18/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
48.8 |
| Comorbidities |
back pain, OA-back, lower joint pain, increasing fatigue and shortness of breath |
| Policy |
Must be medically necessary |
| Comments |
the doctor's office filed the paperwork, I made sure my PCP was uptodate with my desire to followup on this, and the insurer and the doctor's office handled the paperwork. All I had to do was find in plan doctors with privileges at SouthCrest for the pre opt exams. |
| Source |
Ej J |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after appeal letter (06/12/02) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
4 (141 weeks) |
| Comorbidities |
Hypertension, Depression, Hypothyroidism, Arthritis |
| Policy |
Don't know |
| Comments |
My approval came on July 31st after refaxing my medical history from my PCP. Seems Aetna misdirected it originally. I think I've noticed a trend of foot-dragging on Aetna's part, i.e. other people's comments about their experiences with this insurer. It seems as if they want to really make us work for it!
PREVIOUS POST: I am presently waiting on completion of their review. It has taken longer for me because I just changed Insurer in Jan. plus they needed additional information from my PCP as to previous weight loss.
I have not had any negative dealings with them but it does seem to take a while. I changed to Aetna from my employer because as a dependant on my husband's insurance- Corporate Benefits/Armstrong World Industries, I could not have the surgery. They have a written exclusion. Wish we could get that changed. |
| Source |
Mary M |
| Insurer Policy |
Aetna (Open Access) |
| Insurer Status | Approved after first letter (06/14/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
21 |
| Pre-Op BMI |
47.2 |
| Policy |
Must be medically necessary |
| Comments |
They wanted to verify doctor surpervised diets, but responded within a four to six weeks or so of that information. |
| Source |
Suzan B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/15/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
8 |
| Pre-Op BMI |
45.5 |
| Comorbidities |
Hypertension, sleep apnea, acid reflux, very sore knee joints |
| Policy |
Must be medically necessary |
| Comments |
It took eight weeks to get approved. However, my first request was sent to a wrong department which I did not find out for almost 3 weeks. A second request was sent to a different address which a very informative customer rep gave me and it took another 3 weeks to hear from Aetna. Before making a decision, Aetna requested a detailed weight and diet history. They also wanted records from at least two medical doctors that have treated my obesity. Once I got this all together, I hand delivered it to Michelle at Dr. Gorospe's office and she faxed my records. Within 2 weeks I was approved.
Every time I called Aetna, I made notes of conversation, who I talked with and the date. Most of the customer reps were very nice, but remember, all they can do is pull up your account and read from the screen. I got three different answers when I asked for my status, either they had no record of receiving my request or my request was in the precertification dept., pending, or "Yes, you are approved!" Those were the sweetest words that I have heard in a long time.
It is my opinion to always be polite and talk kindly to people. As a result I believe you will get much better cooperation.
Yes, I highly recommend Aetna health insurance. |
| Source |
Cindy T |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/10/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| MD-supervised programs |
4 (87 weeks) |
| Comorbidities |
Sleep Apnea |
| Policy |
Must be medically necessary |
| Comments |
They have stalled a lot in the past, yet always paid. They do offer coverage for certain types of WLS. With BMI requirements and documented history of repeated failure.
They we're good about handling this, it was just hard getting the Dr.'s office to send the right paperwork. |
| Source |
Samantha K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/18/02) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
5 (80 weeks) |
| Source |
Mildred R |
| Insurer Policy |
Aetna (PPO PRONET) |
| Insurer Status | Approved after appeal letter (03/21/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| MD-supervised programs |
4 (71 weeks) |
| Comorbidities |
arthritis, high blood pressure, depression |
| Policy |
Must be medically necessary |
| Comments |
Everyone I talked with, was very nice. But you have to be persistent. I would call them on Monday to see how everything was going. They would tell me what they need to have and I would get it faxed to that day if it was something they need from me. If it was something that need to come from the surgeons office I would call them as soon as I hung up, to see if they were getting what they needed so they could get it turned in.
I would wait a couple of days and start over again. Make a journal of who you talked to and what was said on each phone call. I was very pleased with my insurance company. They were very quick and friendly. The doctors office could have been a little faster sometimes. Remember the squeaky wheel gets the grease. |
| Source |
Janette W |
| Insurer Policy |
Aetna (epo) |
| Insurer Status | Approved after appeal letter (09/12/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
25 |
| Pre-Op BMI |
54.1 |
| MD-supervised programs |
3 (40 weeks) |
| Comorbidities |
diabeties,high cholestoral,sleep apnea,gerd,asthma,orthostasis hypotension,venous statis & possible |
| Policy |
Written exclusion policy |
| Comments |
Finally approved. It seems to me that you almost always have to appeal. They took the full 30 days to answer but at least I am approved and very glad. I think that the insurance companys want to know if you are really serious about having the surgery.It has been very difficult hard to get a straightanswer you get different stories from everyone that you talk too. They were not clear as to why they denied my first request, my pcp wrote and called them to get some answers and they said they never recieved anything so why did they deny me then. i think that they stall because it took one person at my job a year to get approved and they met all the criteria. I do think that eventually presistence does help. Be prepared to fight and do not give up it is your life and you have the right to live it. They need to stop and think that they are dealing with a human life at stake and for some of us this surgery is life saving. |
| Source |
Connie C |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (10/15/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
45.4 |
| Comorbidities |
Degenerative arthritis |
| Policy |
Don't know |
| Comments |
I didn't have to deal with them at all, the Dr's office sent in my paperwork and about a month later I got a call from the Insurance company telling me I had been approved.
Don't know.
Don't know.
Don't know. |
| Source |
Stephanie H |
| Insurer Policy |
Aetna (pos) |
| Insurer Status | Approved after appeal letter (03/05/02) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
6 |
| Pre-Op BMI |
45.8 |
| MD-supervised programs |
5 (122 weeks) |
| Comorbidities |
Diabetes, hypertension, hyperlipid, high triglycerides, kidney problems |
| Policy |
Must be medically necessary |
| Comments |
Aetna POS has a procedure that needs to be followed. They were friendly and responsive overall but some customer service reps were much more helpful than others. If I had proof that I have been 100 lbs overweight for over 5 years and written documentation from my doctor of the diets I had been on, I believe I would have been approved very quickly.
Persistence and patience really helps with this insurance company.
Yes I would recommend this insurance. They are paying for the doctor and hospital fees at 100%.
|
| Source |
Suzanne C |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (03/28/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
52.7 |
| Comorbidities |
Hypertension, Diabetes, Family history of heart problems |
| Policy |
Must be medically necessary |
| Comments |
So far they have been very helpful, but I'm just starting the process. I have talked with the pre-cert group to find out what information they will need initially. Hopefully this will be a smooth ordeal. 5/16/02 - It wasn't as smooth as I had hoped for but I'll take it. I got my approval in 48 hours of the time they received the surgeon's letter. They were always very helpful and understanding. Thanks, Aetna! |
| Source |
Kathy S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | First letter sent - still waiting (04/10/02) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
2 (48 weeks) |
| Comorbidities |
HYPERTENSION, LOW BACK PAIN AND KNEE JOINT PAIN |
| Policy |
Must be medically necessary |
| Source |
Susan L |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | First letter sent - still waiting (04/11/02) |
| MD-supervised programs |
4 (23 weeks) |
| Source |
Deanna A |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after appeal letter (02/07/02) |
| Surgery Type |
RNY |
| Weeks to approval |
4 |
| Policy |
Must be medically necessary |
| Comments |
It was hard. They first letter went out and no results. I called their office every week for two weeks. I then found out that we were sending the info to the wrong place. The lady told me that if I would have my Doc's office fax it to her she would then hand carry it over to the right place. After a week after faxing the letter again I called the predetermination department (after I got the number from a friend who works for aetna and yes they do have a phone number no matter what customer service says) the lady told me that there was no way that the other lady could have delivered my letter because customer service was in Oklahoma and predetermination was in Texas and that would have been a mighty far walk. So again I had my Doc's office fax the forms and it took just another week to be approved after submitting weight loss history. Three weeks later I received a letter telling me that I could not have the surgery. I had to fax them my approval letter and the couldn't believe it. The had no record of this approval. Well I told them now you do. |
| Source |
Stacy S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after appeal letter (08/02/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
10 |
| Pre-Op BMI |
50.9 |
| Comorbidities |
PCOS, Hypothyroidism |
| Policy |
Must be medically necessary |
| Comments |
This company is very frustrating to deal with. After first consult with my surgeon I sent in my paperwork. After a few weeks I called and they said they had never received anything. GRRR... so I then faxed them the information. I was denied on my birthday no doubt a month after first consult. I went to see my PCP and Gyno to get letters. This process took awhile. July 5 I called Aetna and they said they had received my appeal letters. They also mentioned that they had 30 days to decide. COME ON!! 30 days to read 3 letters and stamp APPROVED OR NOT.
Overall, trying to reach the right dept is a nightmare. I had one number from their card.. called and they transferred me to another dept. This went on several times. I finally know which dept I need to talk to but they don't like to give out their telephone number so each time I call I have to go through the whole spill to get transferred. Aetna LOVES to stall. I would like to give some advice to people trying to deal with Aetna... have your letters from your docs ready to send with your initial surgeon consult. This will save time and anxiety. I call about once/week but I recommend calling twice/week if you can stand to deal with them.
Update: Aetna called end of July and says they need more detailed information. I have gathered all that I can and faxed it to them. I finally got a hold of my nurse who is reviewing my case and she is helping me. If you have Aetna.. you need DETAILED 5 year medical history stating dates and weight. You also need a failed diet history from the past 2 years. This information MUST be confirmed by the PCP. Otherwise, you will get the runaround. Once you get in touch with someone who knows you by your letters.. get their phone number and continue to bug them.
Aug 2nd: Was approved by Aetna. Now waiting for surgery date. |
| Source |
Rachel F |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (06/04/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
6 |
| Pre-Op BMI |
59.7 |
| Comorbidities |
Sleep apnea, hypertension, back pains, pain in knees and feet. |
| Policy |
Must be medically necessary |
| Comments |
I gave Aetna about a week after the letter was mailed before calling. They said they had not received the letter. I gave them another week to see if they received the letter. I had the doctors office fax them the letter. I called everyday until they started to process my claim. After a week of me calling everyday, them came back and asked for more information. I had to get medical records for the last 5 years to prove I've been overweight and having problems. So, I got them 8 years history from every doctor I have seen. They approved me 3 days after getting all the history. Once they have your claim in their system, they move fast. |
| Source |
Michell M |
| Insurer Policy |
Aetna (open choice ppo) |
| Insurer Status | First letter sent - still waiting (07/25/02) |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Troy G |
| Insurer Policy |
Aetna (Open Choice ppo) |
| Insurer Status | Approved after first letter (07/27/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
2 (49 weeks) |
| Comorbidities |
Hypertension, joint deteriation |
| Policy |
Must be medically necessary |
| Comments |
It is so new letter only turned in 2 weeks ago. I am still in the waiting game. Will update more when I know.
8/12/2002 Insurance finally states they have recieved information still waiting on decision. PRAY FOR ME!!!!
8/20/2002 I got approved!! YEAH! Took 3 agonizing weeks to get approved..... |
| Source |
Lisa B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | First letter sent - still waiting (08/22/02) |
| Source |
Tracy M |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after 2nd appeal letter (11/7/02) |
| Surgery Type |
Open RNY |
| Comorbidities |
GERD, hypertension, cholesterol, joint pain |
| Policy |
Must be medically necessary |
| Comments |
This insurance company is terrible and frustrating to deal with. They have denied me so now I'm working on my appeal letter. I have spoken with alot of people at Aetna who are very nice and alot of people who weren't nice at all. In fact, one woman told me that Gastric Bypass surgery is just a fad!It took 3 weeks for my appeal to be denied. Now I have reached the final internal level of appeal so I have to appeal to an External Review Organization (whatever that is).Yea! I'm approved! Finally, on November 7, 2002. It's been a nightmare. I sent additional information after they denied my appeal and it got really confusing but I hung in there and kept calling and I guess I made enough noise. |
| Source |
Christy D |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | First letter sent - still waiting (09/10/02) |
| Policy |
Don't know |
| Comments |
9/4/02 I had an appointment to see my PCP and she agreed to put in the referal to the insurance company.
I'm awaiting to hear if my referral was approved.
9/10/02 I heard from my PCP and the referral has been approved. I made my appointment to see Dr. Gorospe for 9.18.02.
9/18/02 AETNA requires 5 year doctor documented diet history. The Surgeon's office will not submit my request to the insurance company with out it because they know it is required, so I'm getting that togther with my PCP. |
| Source |
Sabrina H |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (08/12/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
47.9 |
| Comorbidities |
Asthma |
| Policy |
Must be medically necessary |
| Comments |
the office sent them the forms and they approved me
didn't stall at all
no persistence necessary
get DR letters and list all other past weight loss methods |
| Source |
Amber T |
