| ACMG |
|---|
| Insurer Policy |
ACMG |
| Insurer Status | Approved after first letter (11/21/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
2 |
| Comorbidities |
elevated cholesterol, stressed induced asthma, GERD |
| Policy |
Don't know |
| Comments |
This insurance is through the South Carolina medical association. The only thing they required was a psychiatric evaluation with a MD. When I had the psych. evaluation report faxed to the insurance company, they approved surgery the very next day. I was very impressed |
| Source |
Carol F |
| Acordia |
|---|
| Insurer Policy |
Acordia |
| Insurer Status | Approved after first letter (05/03/02) |
| Comorbidities |
Pulmonary hypertension, moderately enlarged right-side of heart, asthma |
| Comments |
Called after 4 weeks to check on how approval process was going. Had a couple of mix-ups, but eventually got everything straight. Took about 6 weeks. Was approved 1st time. No major hassels. Insurance will pay 80% in-network, with patient paying $300 deductible and out-of-pocket no more than $1000 in a year. |
| Source |
Angela S |
| Aetna |
|---|
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (06/26/00) |
| Surgery Type |
RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
51.4 |
| Policy |
Don't know |
| Comments |
They were great. I was approved mainly because of family medical history they wanted to avoid me having. |
| Source |
Sally C |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after appeal letter (12-1-02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
42.6 |
| MD-supervised programs |
3 (46 weeks) |
| Comorbidities |
Asthma, stress incontinence,GERD, Back pain, swelling of the feet and ancle |
| Policy |
Must be medically necessary |
| Comments |
I am not sure I am just now starting to have to deal with them I will keep you posted. I was denied fairly quickly. I did not tell the lady about the diet I had been on within the last 6 months. SO they denied me right off the bat.So I had to wait for the appeal letter and I wrote a letter as my husband did also and I also got a letter from my PCP that said he had been following me in my weight loss attempts and they took thier time approving me ( however they approved me so that is what counts!) I was approved in like 32 days ( that is when I got the letter!) SO I am happy as I can be. |
| Source |
Heather B |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (5/22/02) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
4 |
| MD-supervised programs |
2 (32 weeks) |
| Comorbidities |
Sleep Apnea, Borderline High B/P, Depression, Family History of Diabetes and Coronary Artery Disease |
| Policy |
Must be medically necessary |
| Comments |
My information and a letter from my surgeon, Dr. Givens, was sent to Aetna on 4-16-02. Of course, they claimed they never received it. On 4/30/02 Dr. Givens office faxed them the information again. A week later they finally admitted receiving it, but was missing a letter from my PCP with my 6 month attempted weight loss within the last 2 years. (This was a little something they threw in when they updated their criteria on 4/23/02). I was able to get the letter and on 5/22/02 I was finally approved. Go to their website www.aetna.com and read their criteria, have everything ready when you go. Have a person's name and fax number to send it directly so they can't tell you it was never received - DON'T mail your information in - IT WILL GET LOST. By the time I found all this out a month had passed. I finally got a name and fax number - Beverly Johnson 1-800-526-9662. Hope that will help someone. Be persistent -call everyday or twice a day. Fax the papers over and over until they tell you they are entered in their system and are being reviewed - then keep calling. |
| Source |
Margaret G |
| Insurer Policy |
Aetna (Managed choice POS) |
| Insurer Status | Approved after first letter (05/29/02) |
| MD-supervised programs |
1 (8 weeks) |
| Source |
Niki E |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (02/11/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
45.5 |
| MD-supervised programs |
2 (44 weeks) |
| Comorbidities |
Arthritis, hypertension, Gerd, Sleep disturbances possibly Sleep apnea, |
| Policy |
Must be medically necessary |
| Comments |
They were very easy to deal with as long as it is medically necessary and you have your PCP and Surgeon and your Medical history and diet history and a Medical Necessity Letter you have no problems but you have to have your ducks in a row. Came back for additional documentation for medical notes supporting a weight loss attempt in the last 2 years for longer than 6 months duration that was medically supervised. only took 1 day for approval after that. Persistence didn't help I don't think but it made me feel better. I highly recommend Aetna as an insurance carrier. I also think having a PCP backing you in a EPO type policy helps your case also. |
| Source |
Kimberly E |
| Insurer Policy |
Aetna (out of area dependence plan) |
| Insurer Status | Approved after first letter (06/14/02) |
| Weeks to approval |
1 |
| Comorbidities |
sleep apnea, depression, hurting joints, asthma |
| Policy |
Must be medically necessary |
| Comments |
Make sure you have written letters from your pcp and other docs like gyn or sleep apnea doctor saying all your problems and how long you have struggled with weight and all your diets.
They stalled b/c they wanted more information on diet history and history of being MO but my letters from my family doc and my pulmonary doctor(who i'd been seeing for apnea for three years) nipped that in the bud.
make sure you have all your ducks in a row. |
| Source |
Jennifer S |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | First letter sent - still waiting (01/07/03) |
| Source |
Amy C |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/24/03) |
| Surgery Type |
Open RNY - proximal |
| MD-supervised programs |
2 (20 weeks) |
| Source |
Ida H |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (05/14/03) |
| MD-supervised programs |
4 (37 weeks) |
| Source |
Doris M |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (10/31/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.0 |
| Comorbidities |
Clinically Diganosed Co-morbidities, hypertension |
| Policy |
Must be medically necessary |
| Comments |
BTC took care of all the paper work, when they sent it over the first time, Aetna requested my doctors records all that was sent and in a matter of 2 weeks I had an approval. They did not stall at all with me, I was very scared that my approval would take forever or not come at all but it did and I am so happy. I would recommend that they make sure they have all their records from their primary doctor, a letter from you primary can't hurt and recent efforts to lose weight. |
| Source |
M R |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Denied after first letter (10/17/03) |
| Comorbidities |
Arthritis, hypertension, sleep apnea, high cholesteral & triglycerides, acid reflux |
| Policy |
Must be medically necessary |
| Comments |
They were very curt, definite and you felt like they were a recording.
I was denied within 4 days.
They changed their policy 30 days before my denial. At first everything was approved, but a directive written Sepember 23, 2003, denies 90% bariatric surgeries, even if medically necessary. Even then, requirements are strict, time limited, and your doctor must have listed everything in great detail.
I do not sense they will respond to persistent requests and pressure but will try when surgery is done.
I would write to this company and protest the new directive (#157) and I would get other insurance.
I am 65 and cannot wait to go through all the process they require. I want to live and I need help now, not when I have diabetis and heart problems. |
| Source |
Charlene A |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/14/04) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
59.2 |
| Comorbidities |
Diabetes, arthritis, Sarcadosis, High Blood Pressure |
| Policy |
Must be medically necessary |
| Comments |
They were very good, and we have no trouble at all. |
| Source |
Robin J |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/02/04) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
51.0 |
| Comorbidities |
GERD, hiatal hernia, sleep apnea, arthritis |
| Comments |
It was easy. |
| Source |
Cheryl P |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Denied after first letter (05/20/04) |
| Policy |
Must be medically necessary |
| Source |
Bianca C |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after appeal letter (06/09/04) |
| Surgery Type |
Laparoscopic Lap Band |
| Source |
J P |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (06/16/04) |
| Comorbidities |
Sleep apnea,diabetes,fatty liver |
| Policy |
Must be medically necessary |
| Comments |
Just started so I'll let you know... |
| Source |
Big Daddy J |
| Insurer Policy |
Aetna (Tenet Select) |
| Insurer Status | Approved after first letter (06/21/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
47.9 |
| Source |
Sherry F |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (sept 03) |
| Comorbidities |
yes, scoliosis |
| Policy |
Must be medically necessary |
| Comments |
They seem to be helpful but do stall. |
| Source |
Patricia D |
| Insurer Policy |
Aetna (pchs) |
| Insurer Status | First letter sent - still waiting (10/05/04) |
| Source |
Gregory M |
| Insurer Policy |
Aetna (lonnicerivers) |
| Insurer Status | Approved after first letter (10/21/04) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
2 (12 weeks) |
| Comorbidities |
hypertension high cholesterol elevated urin microalbumurea creatinine |
| Comments |
i really don't know it has been four weeks today and i have heard nothing from my insurance company it is very frustrating having to play this waiting game... I wish they would at least touch bases with me on my status |
| Source |
Lonnice R |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/06/04) |
| Policy |
Don't know |
| Source |
Susan G |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/21/05) |
| Surgery Type |
Laparoscopic Lap Band |
| Pre-Op BMI |
42.0 |
| Source |
Christine A |
| Insurer Policy |
Aetna (Select) |
| Insurer Status | Approved after first letter (03/29/06) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
3 |
| Comorbidities |
Chronic skin conditions, Depression, GERD, Hypertension, Shortness of breath, Stress incontinence, j |
| Policy |
Must be medically necessary |
| Comments |
They let the package my doctor's office sent in a fax queu for 10 days despite the fact that I called twice to check on the status. On the 3rd phone call I finally was connected with a sympathetic representative that took my fax out of the queu and activated the request. My request was approved 5 days later. My only recommendation is to keep on their case (but be nice about it) and things should go smoothly as long as you've followed their requirements to the letter. |
| Source |
Cathy H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/28/06) |
| Comorbidities |
Hypercholesterolemia, Stress incontinence, Sciatica |
| Policy |
Don't know |
| Source |
Jean J |
| Insurer Policy |
aetna (PPO) |
| Insurer Status | Approved after first letter (6/15/06) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
43.3 |
| Comorbidities |
Arthritis, Hypercholesterolemia |
| Policy |
Don't know |
| Comments |
Aetna is not too bad to deal with IF you follow their requirements. There is NO way to get around them. They require a 6 month supervised diet or 3 month multidisciplinary regimen along with 5 years of weight history. I was approved in 2 weeks. |
| Source |
Christie S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (04/12/06) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
2 (78 weeks) |
| Comorbidities |
GERD, Diabetes, Hypertension, Depression, Hypercholesterolemia, Sleep Apnea |
| Policy |
Must be medically necessary |
| Source |
Just T |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (7/07/2006) |
| Surgery Type |
Laparoscopic RNY - distal |
| Policy |
Don't know |
| Source |
Pam M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/13/06) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
43.0 |
| Comorbidities |
GERD, Hypertension, Chronic skin conditions, Stress incontinence, Asthma, infertility, joint pain |
| Policy |
Must be medically necessary |
| Comments |
Aetna was freakin awesome!!! They approved me in less than a few hours when everything was processed!! I can't complain about them at all!!!! They are covering it at 100%.
|
| Source |
Rachel K |
| Insurer Policy |
AETNA (PPO) |
| Insurer Status | (06/01/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Hypertension, Depression, Shortness of breath |
| Policy |
Must be medically necessary |
| Comments |
Dealing with Aetna was so easy for me! Dr. Prickett's office did all of the work! My husband was losing his job after 15 years and Dr prickett's office scheduled my surgery for Sept. 25, a Monday. I got all the paperwork they needed to them on the Tuesday before and Holland (from Dr Prickett's office) called me on Thursday and said it was approved!!! It only took 2 days. If you do everything they ask you to do, you should have no problems! |
| Source |
Jodie B |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | (06/12/06) |
| Surgery Type |
Laparoscopic Duodenal Switch |
| Pre-Op BMI |
54.0 |
| Comorbidities |
Stress incontinence, Venous stasis disease |
| Source |
Cyndi R |
| Insurer Policy |
Aetna (Choice II) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Sleep apnea, arthritis, diabities |
| Policy |
Must be medically necessary |
| Source |
Carol P |
| Insurer Policy |
Aetna (Open Access) |
| Insurer Status | Approved after first letter (6/13/07) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Comorbidities |
Diabetes, Hypetension, Sleep Apnea, Arthritis |
| Policy |
Must be medically necessary |
| Comments |
They were prompt and very courteous, did not have any problems at all. They let me know what was needed and I supplied them with all necessary info with the help of my Primary Physician and Weight Loss Staff. |
| Source |
Tachia S |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
38.4 |
| Comorbidities |
Hypertension, Depression, sleep apnea, GERD |
| Policy |
Must be medically necessary |
| Source |
Billie C |
| Insurer Policy |
AETNA |
| Insurer Status | Approved after first letter |
| Weeks to approval |
2 |
| Pre-Op BMI |
39.0 |
| Policy |
Must be medically necessary |
| Source |
Tammy F |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (3/17/08) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
55.1 |
| Comorbidities |
Shortness of breath, Sleep apnea |
| Policy |
Don't know |
| Source |
Jessica B |
| Insurer Policy |
AETNA (EPO) |
| Insurer Status | Approved after first letter (January 2, 2008) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
1 |
| Comorbidities |
HIGH BLOOD PRESSURE, LAB WORK INDICATES CHOLESTEROL IS STARTIN TO GO UP,ALSO SUGAR LEVELS ARE STARTI |
| Policy |
Must be medically necessary |
| Source |
Lawanda W |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
12 |
| Comorbidities |
arthritis, hypertension |
| Policy |
Must be medically necessary |
| Source |
Christina E |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/05/2008) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Sleep apnea |
| Policy |
Must be medically necessary |
| Source |
Sl B |
| Aetna Choice Pos II |
|---|
| Insurer Policy |
Aetna Choice Pos II |
| Insurer Status | Approved after first letter (10-1-07) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
46.7 |
| MD-supervised programs |
2 (78 weeks) |
| Comorbidities |
Phelbitis, Heel spurs, fam hx diabetes |
| Policy |
Must be medically necessary |
| Source |
Angela C |
| Insurer Policy |
Aetna Choice POS II |
| Insurer Status | Approved after appeal letter (06/04/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
GERD, Hypertension, Depression, Hypercholesterolemia, Shortness of breath, Stress incontinence |
| Policy |
Must be medically necessary |
| Source |
Jennifer W |
| Aetna US Healthcare |
|---|
| Insurer Policy |
Aetna US Healthcare (Managed Care) |
| Insurer Status | Approved after appeal letter (11/2005) |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Source |
Harvey B |
| Alcoa Building Products |
|---|
| Insurer Policy |
Alcoa Building Products (Managed/Med) |
| Insurer Status | Approved |
| Comments |
They have a policy that states specifically that they do cover procedures for morbid obesity. There are no waiting periods or pre-existing conditions. |
| Source |
Kelly R |
| Alliance |
|---|
| Insurer Policy |
Alliance (PPO) |
| Insurer Status | Approved after first letter (02/25/2004) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
Edema |
| Policy |
Must be medically necessary |
| Comments |
I had no problems with my insurance company. My doctors office didn't fax everything over until 2-19-04 around 5:00pm, so my insurance company didn't technically get it until 2-22-04. By 2-25-04 I had my approval. |
| Source |
Kim M |
| Allmerica |
|---|
| Insurer Policy |
Allmerica |
| Insurer Status | Approved after first letter (06/27/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
7 (108 weeks) |
| Comorbidities |
UPPER AND LOWER HERNIATED DISC, LUPUS, JOINT PAIN, ACID REFUX,BUNIONS, HEEL SPURS, ARTHRITIS AND ALS |
| Policy |
Must be medically necessary |
| Comments |
I WAS TRULY AMAZED AT THE PROFESSIONALISM THAT THEY USED IN DECIDING MY CASE FOR SURGERY. BASED ON ALL THE INFORMATION I HAD RESEARCHED ON INSURANCE CARRIERS I HAD PREPARED MYSELF FOR AN ENORMOUS FIGHT WITH THEM ON THIS ISSUE. INITIALLY, I HAD A CASE MANAGER WHO SHARED WITH ME THAT HEALTH CARE STRATEGIES VIEWS THIS AS COSMETIC. WELL, I MUST SAY I FOUND THIS TO BE QUITE SCARY. BUT, WHEN I CALLED IN THE VERY FIRST TIME AFTER I HAD SUBMITTED ALL PERTINENT INFORMATION. I HAD BEEN APPROVED! YOU SEE A COUPLE OF WEEKS HAD GONE BY BEFORE I EVEN BOTHERED TO CHECK BECAUSE MY MOM PASSED. SO CERTAINLY, I REALLY COULD NOT TAKE ANYMORE DEPRESSING NEWS. GOOD NEWS! GOOD NEWS! WELL NOW I AM TRYING TO FIND THE RIGHT SURGEON. SO, I CAN ONLY SAY GREAT THINGS ABOUT MY HEALTH CARE PROVIDER. REALLY GREAT! |
| Source |
Alice G |
| American LifeCare |
|---|
| Insurer Policy |
American LifeCare |
| Insurer Status | First letter sent - still waiting (06/19/04) |
| MD-supervised programs |
5 (168 weeks) |
| Comorbidities |
Sleep apnea, arthuritis, |
| Policy |
Don't know |
| Source |
Robin F |
| AmeriHealth |
|---|
| Insurer Policy |
AmeriHealth (PPO) |
| Insurer Status | Approved after first letter (05/30/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
42.0 |
| MD-supervised programs |
2 (4 weeks) |
| Comorbidities |
GERD |
| Policy |
Must be medically necessary |
| Comments |
No problems at all. They did not seem to stall. I happened to call just to see if they had made a decision yet and they told me that it had been approved and my doctor would be getting a letter soon. It took less than 2 weeks. They had 30 days for the predetermination. |
| Source |
Wanda M |
| Insurer Policy |
AmeriHealth (PPO) |
| Insurer Status | Approved after first letter (03/01/04) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
52.3 |
| Comorbidities |
Hypertension, bladder problems, foot problems |
| Policy |
Must be medically necessary |
| Source |
Lisa C |
| Insurer Policy |
AmeriHealth (PPO) |
| Insurer Status | Denied after first letter (02/23/05) |
| Policy |
Don't know |
| Source |
Ivory S |
