| Aetna |
|---|
| Insurer Policy |
Aetna (AlaskaCare) |
| Insurer Status | First letter sent - still waiting (01/01/01) |
| MD-supervised programs |
2 (104 weeks) |
| Source |
Nancy B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (04/08/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Comorbidities |
You must have a BMI of 40 or higher, and some other medical items as well. |
| Comments |
They were great to deal with. I waited about 4 weeks for confirmation. The reason it took that long was because they were moving facilities and were behind on some paperwork. They were ery nice to deal with. I was so anxious that I called about every few days after the first 2 weekes were up just to see if they had given the approval yet. |
| Source |
Alan H |
| Insurer Policy |
Aetna (MC PRONET) |
| Insurer Status | Approved after first letter (10/10/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
42.3 |
| MD-supervised programs |
4 (66 weeks) |
| Comorbidities |
Severe Sleep Apnea/Hypertension/Diabetes/Reflux |
| Policy |
Must be medically necessary |
| Comments |
My Doctor's first letter to Aetna disappeared into thin air. 3 Weeks ago, I called Aetna to check up on request status and found that the letter was sent to a wrong PO Box #. I spoke with 3 seperate Aetna phone rep's and got 3 seperate Fax #'s. After another 2 weeks, no-one at Aetna had record of receipt of anything. My surgeons office was as confused as I about this. So... last Friday (4 weeks) I got a person from Aetna ON THE PHONE with someone from my surgeons office. The correct fax # resulted in several faxes back and forth and my approval came, on Wednesday... a mere 5 days after getting them together. Approval letters were sent to myself and my surgeon, yesterday, Thursday! MY RECOMMENDATION: Take control of the communicating process. My surgeon's original letter of 1 month ago has still not shown up at Aetna! Update: That first letter never was found. TAKE CONTROL OF THE COMMUNICATION PROCESS BETWEEN YOUR INSURANCE COMPANY AND YOUR SURGEON'S OFFICE!!! |
| Source |
Jeff S |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (09/15/02) |
| Surgery Type |
Open RNY |
| Policy |
Must be medically necessary |
| Source |
Barry H |
| Insurer Policy |
Aetna (open access aetna select) |
| Insurer Status | Approved after first letter (06/25/08) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
1 |
| Pre-Op BMI |
49.3 |
| MD-supervised programs |
1 (24 weeks) |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
It went so much easier than I thought it would. Ive had a bmi over 40 for at least the past two years, I did my 6 month md supervised diet, and turned in a booklet of my weighs ins from weigh watchers in 2005. I had my md supervised diet medical records faxed to the dr office along with my medical records from my primary doctor to prove how long ive been over weight. It only took 1 week for me to get approved! It was sooo easy. I was worried because I've heard nothing but horror stories from other people on here that have aenta, but mine was a breeze. |
| Source |
Sarah G |
| Alliance |
|---|
| Insurer Policy |
Alliance (Prime) |
| Insurer Status | Approved after first letter (2/1/2004) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| MD-supervised programs |
1 (52 weeks) |
| Comments |
Approve quickly without problems. Friendly and fast. Really like their fast approval. |
| Source |
Susan (Sue) B |
| American Administrators |
|---|
| Insurer Policy |
American Administrators (sicango oyate ho inc.) |
| Insurer Status | First letter sent - still waiting (07/15/03) |
| MD-supervised programs |
4 (141 weeks) |
| Source |
Melissa B |
| Araz Group |
|---|
| Insurer Policy |
Araz Group (PPO) |
| Insurer Status | Approved after first letter (05/29/04) |
| Surgery Type |
Open RNY - proximal |
| Source |
Linda P |
| Avera Health |
|---|
| Insurer Policy |
Avera Health |
| Insurer Status | Denied after first letter (04/10/02) |
| Surgery Type |
Open RNY - distal |
| Source |
Bev J |
| Banner Health |
|---|
| Insurer Policy |
Banner Health (Choice Plus) |
| Insurer Status | Approved after first letter (07/20/00) |
| Surgery Type |
Open RNY |
| Comments |
I felt that they were pretty helpful I had to make a few calls to them to find out what the next step would be. But every one was very nice and helpful. Dealing with insurance can sometimes be very stressful. My Dr office followed up about daily after they had gotten all the info . I would recommend that you have all your documentation of what attempts you have made for wight loss and documented comorbidities |
| Source |
Marsha O |
| BCBS |
|---|
| Insurer Policy |
BCBS |
| Insurer Status | Approved after appeal letter (04/15/05) |
| Source |
BabyBumblebee |
| Insurer Policy |
BCBS |
| Insurer Status | Approved after first letter (July 13, 2007) |
| Surgery Type |
Laparoscopic Lap Band |
| Comorbidities |
sleep apnea, hypertension, GERD |
| Policy |
Must be medically necessary |
| Comments |
Very Pleasant, recieved a follow-up call and interview when told that surgery was approved. Had to lose enough weight to have a BMI of 49.9 or lower. Started on June 19, 2007 and reached goal by July 6th with approval by July 13. My doctor has an assistant that deals directly with the insurance companies, so there was no problems whatsoever. |
| Source |
Susan V |
| Insurer Policy |
bcbs |
| Insurer Status | |
| Surgery Type |
Open VGB |
| Pre-Op BMI |
34.6 |
| MD-supervised programs |
2 (1989 weeks) |
| Source |
Sande L |
| BCBS SD |
|---|
| Insurer Policy |
BCBS SD |
| Insurer Status | Approved after 2nd appeal letter (OCT12) |
| Surgery Type |
Laparoscopic Lap Band |
| Policy |
Don't know |
| Source |
Annette G |
| Blue Coss Blue Sheild of SD |
|---|
| Insurer Policy |
Blue Coss Blue Sheild of SD |
| Insurer Status | |
| Comorbidities |
Sleep apnea, GERD, Arthritis, Hypertension, Hypercholesterolemia, Shortness of breath |
| Source |
Larry W |
| Blue Cross |
|---|
| Insurer Policy |
Blue Cross |
| Insurer Status | Approved after first letter (04/02/05) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
47.8 |
| Source |
Donna H |
| Insurer Policy |
Blue Cross (PPO) |
| Insurer Status | Approved after first letter (05/31/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
45.1 |
| Policy |
Must be medically necessary |
| Comments |
The persons I talked to were all very friendly and helpful. I was very persistent in finding out if I was approved or not and they were very patient and kind. They were even very excited when I was approved! |
| Source |
Debra H |
| Insurer Policy |
Blue Cross (PPO) |
| Insurer Status | Approved after first letter (07/21/05) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
46.8 |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Alison H |
| Insurer Policy |
Blue Cross (federal employee) |
| Insurer Status | Approved after first letter (09/09/05) |
| Source |
Tonna H |
| Insurer Policy |
Blue Cross ( PPO) |
| Insurer Status | Approved after first letter (10/11/05) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
54.8 |
| Source |
Tamara H |
| Insurer Policy |
Blue Cross (Kenneth Rosane) |
| Insurer Status | Approved after first letter (02/23/06) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
47.3 |
| Comorbidities |
Chronic skin conditions, GERD, Stress incontinence |
| Source |
Becki R |
| Insurer Policy |
Blue Cross (PPO) |
| Insurer Status | Approved after first letter (05/14/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
Sleep apnea, Depression, Hypercholesterolemia |
| Policy |
Must be medically necessary |
| Comments |
It was easy! All I did was give the WSL coordinator @ Primecare Clinic, Jean E. RN all the info & supporting documents she requested. Jean sent the paperwork in to Blue Cross & I was approved in a week & a half. Sue from Blue Cross even called to let me know the letter was coming & asked several questions to make sure things were going well for me in the whole process. Sue said she will be calling back to check up on me post op too! I am very impressed so far. |
| Source |
Donovan G |
| Insurer Policy |
Blue Cross |
| Insurer Status | Approved after appeal letter (5-4-07) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
7 |
| Pre-Op BMI |
38.3 |
| Comorbidities |
sleep apnea, hypertension, type II diabetes, thyroid, high chloestrol |
| Policy |
Must be medically necessary |
| Source |
Kari H |
| Insurer Policy |
Blue Cross |
| Insurer Status | Approved after appeal letter |
| Surgery Type |
Lap Band |
| Source |
Kim L |
| Blue Cross and Blue Shield of Minnesota |
|---|
| Insurer Policy |
Blue Cross and Blue Shield of Minnesota |
| Insurer Status | Approved after first letter (03/05/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Source |
Lucy H |
| Blue Cross Blue Sheild |
|---|
| Insurer Policy |
Blue Cross Blue Sheild |
| Insurer Status | Approved after first letter (11/28/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
42.3 |
| Comorbidities |
High Blood Pressure, Acid Reflux, Gallbladder removed, feet,knee,back, joint pain |
| Policy |
Must be medically necessary |
| Comments |
I actually had e-mail a lady who was on the bariatric coordinator team and she was so helpful. When I contacted her that all my paper work was faxed, she checked everyother day to see what the status was. When 2 weeks was up and she still hadn't recieved anything, she went directly to that department and got the approval right away. She was such a blessing and BCBS is very lucky to have such an awesome person working for them. I do recommend contacting them all the time so you're not lost in the paperwork. |
| Source |
Maryann K |
| Insurer Policy |
Blue Cross Blue Sheild |
| Insurer Status | Approved after first letter (01/17/06) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
39.3 |
| Comorbidities |
GERD, Shortness of breath, Sleep apnea, Stress incontinence |
| Source |
Garnet P |
| Blue Cross Blue Sheild of ND |
|---|
| Insurer Policy |
Blue Cross Blue Sheild of ND (Blue Card PPo) |
| Insurer Status | Approved after first letter (05/17/06) |
| Comorbidities |
Arthritis, Depression, Shortness of breath, Stress incontinence |
| Source |
Ben S |
| Blue Cross Blue Shield |
|---|
| Insurer Policy |
Blue Cross Blue Shield |
| Insurer Status | Approved after first letter (09/08/05) |
| Source |
Carol A |
| Blue Cross Blue Shield of Wisconsin |
|---|
| Insurer Policy |
Blue Cross Blue Shield of Wisconsin |
| Insurer Status | Approved after first letter (11/29/05) |
| Comorbidities |
Depression, GERD, Hypercholesterolemia, Hypertension, Sleep apnea, Stress incontinence |
| Source |
Christina S |
| Blue Cross/Blue Shield |
|---|
| Insurer Policy |
Blue Cross/Blue Shield (Group PPO) |
| Insurer Status | Approved after first letter (03/15/2005) |
| Surgery Type |
Open Revision |
| Weeks to approval |
2 |
| Pre-Op BMI |
47.3 |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
Acid Reflux, Barretts Esophagus |
| Policy |
Must be medically necessary |
| Comments |
Very helpful. I would recommend this company to others. Personal case manager for my surgery is a great asset of this company. |
| Source |
Patty D |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (01/29/01) |
| Surgery Type |
Open Other |
| Pre-Op BMI |
40.1 |
| Source |
Sheila |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (07/03/01) |
| Weeks to approval |
1 |
| Pre-Op BMI |
48.6 |
| Comments |
My carrier considered my letter of request and determined it was medically necessary for me to have the surgery. I was approved in a matter of days after they received the request. |
| Source |
J J |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | First letter sent - still waiting (03/05/01) |
| Source |
Ann B |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after appeal letter (04/28/01) |
| Weeks to approval |
44 |
| Pre-Op BMI |
50.3 |
| Comments |
My insurer was good to me. When i applied i had only been at my job a few months and they required that i be there for 11 months before i could have the surgery and once we got past my 11 months they approved me as soon as they got the letter. |
| Source |
Lisa W |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (06/05/01) |
| Source |
Deb S |
| Insurer Policy |
Blue Cross/Blue Shield (PPO) |
| Insurer Status | Approved after first letter (07/16/01) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
2 (78 weeks) |
| Policy |
Must be medically necessary |
| Comments |
So far so good. The gal I spoke with was very nice. I was concerned that there were policy limitations etc. Everything will be covered as long as they feel it is medically necessary. Since I have almost 200 lbs. to lose, don't think it will be a problem ! |
| Source |
Lisa |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (08/31/01) |
| Surgery Type |
Laparoscopic RNY |
| Source |
Lisa K |
| Insurer Policy |
Blue Cross/Blue Shield (Family CMM) |
| Insurer Status | Approved after first letter (6/15/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
57.0 |
| MD-supervised programs |
1 (24 weeks) |
| Comorbidities |
Sleep apnea, hypertension, arthritis in knees |
| Policy |
Must be medically necessary |
| Comments |
Dealing with this company has been very easy. This is insurance through my wife's work because the carrier at my employment (Intermountain Administrators) have a written exclusion for WLS. |
| Source |
K.C. J |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (10/18/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Comments |
Bariatric Treatment Center handled all insurance information. The only contact that I had with BC/BS was calling to bug them to see if they had an answer yet. |
| Source |
Becky G |
| Insurer Policy |
Blue Cross/Blue Shield (PPO?) |
| Insurer Status | Approved after first letter (01/18/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
1 (6 weeks) |
| Comorbidities |
GERD, hypertension,Diabetes, Infetility, joint problems, sleep apnea...etc etc etc |
| Policy |
Must be medically necessary |
| Comments |
They didn't really commit to paying for it or denying it. We read in the manual what they consider "medically necessary" and we qualify. Dr. Office said they usually pay.. even if they don't we still want surgery. They have tried to pull a couple of fast ones.. need to be observant... |
| Source |
Allie A |
| Insurer Policy |
Blue Cross/Blue Shield (PPO) |
| Insurer Status | Approved after first letter (02/08/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.0 |
| Policy |
Must be medically necessary |
| Comments |
I did not have any problems at all. My doctor sent them a fax and in 2 days we had an approval. I was impressed. |
| Source |
Melissa S |
| Insurer Policy |
Blue Cross/Blue Shield (Wellmark) |
| Insurer Status | Approved after first letter (02/26/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
40.8 |
| Comorbidities |
100 pounds or more overweight. Less then 100 accepted if Co-morbidities are present. I had Hyperte |
| Policy |
Must be medically necessary |
| Comments |
So far no problems. Had surgery the 21st of February so claims settlements haven't started coming in yet. |
| Source |
Brenda F |
| Insurer Policy |
Blue Cross/Blue Shield (group) |
| Insurer Status | Approved after first letter (03/19/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Comorbidities |
arthritis, hypertension, GERD |
| Policy |
Don't know |
| Comments |
Dealing with Blue Cross/Blue Shield was excellent. They responded quickly and positively. I would highly recommend them to others. |
| Source |
Corrine L |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (03/21/03) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
43.6 |
| MD-supervised programs |
2 (38 weeks) |
| Comorbidities |
HTN, arthritis, asthma, edema |
| Policy |
Must be medically necessary |
| Comments |
Wellmark is so easy to deal with compared to the insurer that my last employer had. Dr. Harris's office sent in a pre-approval request and then Wellmark sent a clear, easy to complete form to my PCP. She filled it out, faxed it back and I had approval within two weeks. I'm very impressed and pleased, to say the least. |
| Source |
Kate T |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (07/09/02) |
| Surgery Type |
Laparoscopic Other |
| Weeks to approval |
1 |
| Pre-Op BMI |
39.5 |
| MD-supervised programs |
3 (13 weeks) |
| Comorbidities |
hypertenstion, urine incontinence |
| Policy |
Must be medically necessary |
| Comments |
The insurance company was really good in handling my approval. They received my letter on July 2nd, 2002 and I was approved on July 9th, 2002. I had no complications at all. |
| Source |
Melissa R |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (06/13/02) |
| Source |
Michelle R |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after 2nd appeal letter (08/07/02) |
| Surgery Type |
Laparoscopic Lap Band |
| MD-supervised programs |
1 (30 weeks) |
| Source |
Sandy H |
| Insurer Policy |
Blue Cross/Blue Shield |
| Insurer Status | Approved after first letter (04/24/03) |
| Surgery Type |
Laparoscopic Lap Band |
| Source |
James C |
| Insurer Policy |
Blue Cross/Blue Shield (ppo) |
| Insurer Status | Approved after first letter (10/21/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
51.7 |
| Source |
Jodie P |
