| Blue Cross Blue Shield |
|---|
| Insurer Policy |
Blue Cross Blue Shield (Anthem with Crane Co) |
| Insurer Status | Denied after first letter |
| Comorbidities |
GERD, Arthritis, Hypertension, Chronic skin conditions, Depression, Hypercholesterolemia, Shortness |
| Source |
Sara P |
| 21st Century Health & Benefits |
|---|
| Insurer Policy |
21st Century Health & Benefits (PPO) |
| Insurer Status | Approved after first letter (04/26/04) |
| Source |
Dawn M |
| A H & L |
|---|
| Insurer Policy |
A H & L (ONE HEALTH PLAN) |
| Insurer Status | Approved after first letter (06/26/02) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
4 (32 weeks) |
| Source |
Susie C |
| AAG |
|---|
| Insurer Policy |
AAG (PPO) |
| Insurer Status | Denied after first letter (12/07/04) |
| Comorbidities |
Arthrities, Diabetes, Hypertension, GERD |
| Policy |
Must be medically necessary |
| Source |
Cassandra A |
| Access Medical |
|---|
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after appeal letter (07/13/00) |
| MD-supervised programs |
1 (8 weeks) |
| Policy |
Don't know |
| Comments |
iam approved for the surgery but they can't find a hospital to have it at so i'm not gonna have the operation.
. |
| Source |
Phyllis S |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (04/02/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
95.7 |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
At first I had UNITED HEALTH CARE PPO and It was a NIGHTMARE. They didn't want to even discuss wieght loss surgery and didn't care if was a medical necessity or not. THEY DONT COVER IT, THAT WAS IT.
Then I was able to get on TENNCARE and they have been nothing but helpful and I was approved after my first letter. It was alot easier than I thought or expected after my other experience. My particular plan is Access Med Plus |
| Source |
Lissa R |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after appeal letter (05/3/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
8 |
| Pre-Op BMI |
41.5 |
| Policy |
Must be medically necessary |
| Comments |
it seemed pretty easy. i knew i would get denied, but the apologized and approved me.
be patient |
| Source |
Erika T |
| Insurer Policy |
Access Medical (hmo) |
| Insurer Status | Approved after first letter (07/22/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Comorbidities |
HTN,Hyperlipidema,SleepApnea Gerdetc. |
| Policy |
Must be medically necessary |
| Comments |
Access Med Plus was great in responding to my request. They did have a change in nedical directors and he requested that I go to the surgeon for an offical diagnoises before they would approve it but after I went to the primary and she wrote her letter then I went to surg. and from there they summitted their stuff. I had copies of all diets attempted, letters from doctors stating that weight loss was needed to help me get rid of co-morbidities,copies of weight loss facilities (receipts) I had been to. I also got copies of medical rcords where I had been to doctors for weight loss that showed the beginning weight and Ending weight,and needless to say I would lose a small amount but gainged it back plus more. All of this I gave copies of to my surg. office, how much of this info she had to use I don't know. but all I do know is Access Med Plus did;t waste any time. I feel that they realize that it's time to start taking care of the problem instead of just treating the symptoms. Thats all for now I'll update clser to surg. |
| Source |
Sherry C |
| Insurer Policy |
Access Medical (Tenn Care) |
| Insurer Status | First letter sent - still waiting (08/03/01) |
| Source |
Aisha P |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after appeal letter (09/02/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
50.7 |
| Comorbidities |
Diabetes,hypertension,painful joints,high cholesterol levels |
| Policy |
Must be medically necessary |
| Comments |
They were really good to work with. The first denial is something they always do and I had no problem with the appeal. I would recommend them to others seeking this surgery. |
| Source |
Teri S |
| ACEC/HealthPlan Services |
|---|
| Insurer Policy |
ACEC/HealthPlan Services |
| Insurer Status | Approved after first letter (06/14/03) |
| Surgery Type |
Laparoscopic RNY |
| Comments |
Approval was very fast with no complications at all. |
| Source |
Rick S |
| Acordia |
|---|
| Insurer Policy |
Acordia (The Initial Group, Inc.) |
| Insurer Status | Approved after appeal letter (03/03/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
12 |
| Pre-Op BMI |
45.7 |
| Comorbidities |
I don't really understand this question. |
| Policy |
Must be medically necessary |
| Comments |
Dealing with the insurance company has been the hardest part of the entire proceedure. They do stall and they will refer you to dozens of other people who will refer you to dozens of others. Yes, the company responded to persistence. I called several times myself and the doctor's office stayed on them also.
Make sure that the doctor is very specific in the health problems related to obesity. |
| Source |
Robin W |
| Insurer Policy |
Acordia (POS) |
| Insurer Status | Approved after first letter (1/26/2006) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
2 (10 weeks) |
| Comorbidities |
hypertension, arthristis, diabetes |
| Policy |
Must be medically necessary |
| Comments |
Make sure you have a WLS program that knows what you need in the way of documentation to speed process along. Have any and all paperwork filled out completely. Get as my letters of support from any doctors that you are seeing that will state surgery will help with that particular condition. |
| Source |
Belinda Y |
| Adminitron |
|---|
| Insurer Policy |
Adminitron (A Cobra plan) |
| Insurer Status | Approved after first letter (10/01/01) |
| Weeks to approval |
3 |
| Pre-Op BMI |
54.0 |
| Comorbidities |
hypertension, border line diabetic, bad knees, |
| Policy |
Must be medically necessary |
| Comments |
I spoke with Karen and she couldn't have been more willing and happy to help me. I felt like she was really trying get it approved as fast as possible for me. I think the panel may have stalled once to Karen but she refaxed everthing and that was all it took. Persistence does help. Yes I have been happy with this insurance. |
| Source |
Gina T |
| Aenta |
|---|
| Insurer Policy |
Aenta (Carlon Dalana Capley) |
| Insurer Status | Approved after appeal letter (09/06/05) |
| Comorbidities |
10-5-04 |
| Policy |
Don't know |
| Comments |
Have a 3 month documation of diet with your Dr. or any Wt. loss company |
| Source |
Dalana C |
| Aetna |
|---|
| Insurer Policy |
Aetna (Graebel Companies) |
| Insurer Status | Approved |
| Comments |
For me, Aetna was wonderful! They approved me within 3 weeks. My policy required a $100/copay only. Every pre-op test requested by my surgeon, was authorized. |
| Source |
Rhenea F |
| Insurer Policy |
Aetna (STANDARD) |
| Insurer Status | Approved after appeal letter (10/05/99) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
59.4 |
| MD-supervised programs |
1 (26 weeks) |
| Policy |
Must be medically necessary |
| Comments |
MY INSURANCE CARRIER SAID THAT ALL THE DRS OFICE WOULD HAVE TO DO IS PRE-CERT AND THAT THEY WOULD PAY 80% |
| Source |
Amelia L |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/05/99) |
| Surgery Type |
Open Other |
| Weeks to approval |
6 |
| Comorbidities |
hypertension |
| Policy |
Don't know |
| Comments |
I called them once a week every week and found one really nice person and used her as my only contact. They sent it to medical director, I continued calling and to my amazement, persistance paid off. |
| Source |
Lisa H |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (06/10/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
3 |
| Policy |
Don't know |
| Comments |
I called them just about everyday. I got hung up on numerous times, and just completely brushed off the rest of the time. So, I got my husbands HR lady involved. After that, it was only a matter of days before I was approved. |
| Source |
Theresa J |
| Insurer Policy |
Aetna (open choice ppo) |
| Insurer Status | Approved after first letter (03/03/00) |
| Surgery Type |
Open RNY |
| Source |
Deborah M |
| Insurer Policy |
Aetna (Managed Choice POS) |
| Insurer Status | Approved after first letter (03/17/00) |
| Source |
Lorri B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/12/2000) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
48.8 |
| Comorbidities |
High Blood Pressure |
| Policy |
Don't know |
| Comments |
My primary care physician, Dr David Collier's staff handled everything. All I did was wait for the approval. I really expected it to be much more difficult. |
| Source |
Tony H |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (04/26/00) |
| MD-supervised programs |
1 (8 weeks) |
| Source |
Patricia M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/07/00) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
49.8 |
| MD-supervised programs |
3 (28 weeks) |
| Source |
Phyllis C |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (03/05/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
2 |
| Pre-Op BMI |
59.1 |
| MD-supervised programs |
2 (28 weeks) |
| Comorbidities |
Sleep apnea |
| Policy |
Don't know |
| Comments |
I actually had no problems with Aetna. I have heard that others have. Dr. Wright no longer takes patients with Aetna or Prudential. |
| Source |
Greg A |
| Insurer Policy |
Aetna (AETNA US Healthcare) |
| Insurer Status | First letter sent - still waiting (07/23/00) |
| Source |
Mark H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/02/01) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
15 |
| Pre-Op BMI |
57.5 |
| Comorbidities |
Sleep Apnea, joint pain |
| Policy |
Must be medically necessary |
| Comments |
Aetna was really great !!!! I mean I really didnt deal with them a great deal.... The reason it took me 15 weeks to get approved was because it took me a while to get the info to resubmit to them after they denied because they needed proof of dr supervised diets!!!!! After I got my butt in gear though this second time around it only took like 8 working days to get approved. One thing I will say is make sure you document everything. They were really friendly!!!! |
| Source |
Kim J |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (08/25/00) |
| Surgery Type |
RNY |
| Weeks to approval |
2 |
| Comorbidities |
Gerd, Sleep Apnea, leg swelling, back pain, migrains |
| Policy |
Must be medically necessary |
| Comments |
I called Aetna before submitting any paperwork or even contacting a doctor to find out what their policy was.
They stated that I had to have a BMI over 40 (mine is 50.2!!) I had to have documented proof that I had attempted a doctor supervised weight loss program (I had two, one doctor charged me $15 just for a copy of my file!) and had not had continued success.
I did not feel that Aetna responded at all to persistence...there is the customer service gate keeper so you never actually talk to the department that is processing your pre-approval. However, they do move fairly quickly...they received the request from my doctor on 10/20/00 and sent the pre-certification approval on 11/7/00.
I would recommend that everyone contact their insurer prior to contacting a doctor. Make sure you have all of your necessary paperwork and documentation when you do contact a doctor. |
| Source |
Heidi F |
| Insurer Policy |
Aetna (Open Choice) |
| Insurer Status | Approved after first letter (11/16/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
59.7 |
| MD-supervised programs |
2 (20 weeks) |
| Policy |
Must be medically necessary |
| Comments |
AETNA is a great provider. They only have TWO requirments that I know of. 1 - your BMI must be over 40 (mine is 58 - 60), and 2 - you have to have documentation of dietary failures that have been monitored by a physician. I listed all the (13) diet names and attempts I have done over the last 13 years, and which ones were monitored by a physician. My family dr. took that and added it to my file. ***** My biggest word of advice with AETNA --- GET DOCUMENTATION!!! |
| Source |
April R |
| Insurer Policy |
Aetna (MC POS) |
| Insurer Status | Approved after first letter (02/23/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| MD-supervised programs |
3 (53 weeks) |
| Comorbidities |
high BP, reflux |
| Comments |
My insurance company was great. It only took them 3 days to come back with an approval even though I've only been covered for two months. |
| Source |
Amanda S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/09/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
arthritis of knees & ankles, chronic lwr back pain, hypertension, sleep apnea, GERD, hyatal hernia, |
| Comments |
It seems like AETNA has everything in order. It only took 4 days from the time that the Dr ofc submitted the paperwork. I just happened to call & they provided me w/ pre-cert #. WOO-HOO |
| Source |
Julie C |
| Insurer Policy |
Aetna (Aetna Open Access) |
| Insurer Status | Approved after first letter (12/27/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
50.9 |
| MD-supervised programs |
2 (16 weeks) |
| Source |
Tyrone T |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/05/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| MD-supervised programs |
3 (49 weeks) |
| Source |
Barbara D |
| Insurer Policy |
Aetna ( us healthcare) |
| Insurer Status | Approved after first letter (09/28/01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
47.8 |
| MD-supervised programs |
2 (18 weeks) |
| Comorbidities |
hypertension, arthritis, gerd, hynatal hernia, swelling of feet & ect., reflux, knee pain & problems |
| Policy |
Must be medically necessary |
| Comments |
Called & they said they only need a pre-treatment letter from my Dr. or the surgeon. So far no problems.. They said it should be approved within 30 days or less & from things I told her there should be no problems.. will update as I know.. Letter got sent in on 24 & they got it 26 & sent it the 28 to the ones to review it & it got approved.. they were very friendly & helpfull.. |
| Source |
Vickie H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/22/01) |
| Surgery Type |
Laparoscopic Lap Band |
| Source |
Dee W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/19/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
54.1 |
| MD-supervised programs |
1 (5 weeks) |
| Comorbidities |
Sleep Apnea |
| Policy |
Must be medically necessary |
| Comments |
Dealing with AEtna was easy! My surgeon's office done it all. |
| Source |
Mary S |
| Insurer Policy |
Aetna (Open Choice PPO) |
| Insurer Status | Approved after first letter (06/04/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
56.0 |
| Policy |
Must be medically necessary |
| Comments |
Actually I have to say that my experience with Aetna has been wonderful. They approved the request very quickly.
I don't think they stalled at all.
Based on a previous experience with them - I would have to say Yes they do respond more quickly if you are persistant.
|
| Source |
Stacie W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/21/01) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
4 0 |
| Source |
Robin P |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/01/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
73.8 |
| MD-supervised programs |
1 (24 weeks) |
| Comorbidities |
Sleep Apnea,Hypertension,Back Pain, Leg Ulcers,the list keep going.... |
| Policy |
Must be medically necessary |
| Comments |
I never dealt with them,Janet from Dr Husted's office took care of all the details and got me approved.I was approved quickly and Janet took care of all the details. |
| Source |
Kyle L |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (08/24/01) |
| Source |
Michelle M |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after first letter (10/23/01) |
| MD-supervised programs |
2 (24 weeks) |
| Source |
Shannon A |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (11/30/01) |
| Comorbidities |
acid reflux, lower back pain, menstrual problems, high blood pressure, retaining water |
| Policy |
Written exclusion policy |
| Source |
Crystal R |
| Insurer Policy |
Aetna (epo) |
| Insurer Status | Approved after first letter (07/26/01) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
5 |
| Pre-Op BMI |
46.6 |
| Comorbidities |
high blood presure, sleep apnia, stress |
| Policy |
Must be medically necessary |
| Comments |
Happily Dr. dyer is at centennial hospital in nashville who provides a staff just to process these medical claims, so for me things went very smoothly as I didnt have to be the pit bull with the insurnace and the letter the insurance company recieved was already a winner, since the ladies in teh processing office had already written many many letters for others and now know just what the insurance company needs to get a big fat YES (sorry no pun intended> if you live in the Nashville area seek out Dr dyer at Centennial medical center (615)329-7933 |
| Source |
Gavin M |
| Insurer Policy |
Aetna (Open Choice PPO) |
| Insurer Status | Approved after first letter (12/19/01) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
arthritis, GERD, heel spurs, infertility, sleep apnea, swelling of legs |
| Policy |
Must be medically necessary |
| Comments |
I got denied my first letter to Optimum Choice then changed to Aetna through husbands plan. I know Aetna is good insurance. I am waiting on approval now.
I got approved after first letter with Aetna, I called and bugged them every day I guess persistance is everything. |
| Source |
Teresa T |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (07/30/02) |
| Weeks to approval |
12 |
| Pre-Op BMI |
59.9 |
| MD-supervised programs |
1 (32 weeks) |
| Comorbidities |
Apnea, hypertension, |
| Policy |
Must be medically necessary |
| Comments |
I had a real hard time. They denied me at first and I had to get documentation of doctor related weight loss programs. I appealed and sent in the information they approved me but the physicians office dropped them and I had to find another surgeon. I had to start all over again for approval. It took a lot of determination, calling but finally got approved. They were definately stallers because if I hadn't been persistant, I still wouldn't be approved.
I would recommend to anyone with this insurance get the documentation of other doctor weight loss programs first before even starting. Be persistant. They will put you off as long as possible. |
| Source |
Patricia J |
| Insurer Policy |
Aetna (EPO) |
| Insurer Status | Approved after first letter (05/01/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| MD-supervised programs |
3 (18 weeks) |
| Comorbidities |
No |
| Policy |
Must be medically necessary |
| Comments |
Aetna is really simple, if you do not have six months of documented weight loss attempts then you must complete three month surgery preparation, which includes nutrition and exercise. You also have to attend at least two support group meetings. As soon as I completed my requirements I was approved in less than a week. I thought three months was so long and because of my work schedule it actually took me four to complete everything and it still feels like it should not be time for my surgery but it is right around the corner. |
| Source |
Alicia B |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (06/18/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
54.8 |
| Comorbidities |
hypertension, edema, polycystic ovary syndrome, reflux, type 2 diabetes, high cholesterol, knee pain |
| Policy |
Must be medically necessary |
| Comments |
The 1st to phone calls I made they acted like they have not recieved anything before i redirected them and said they have...then they gave me the answer "its under review". The third time i called someone actually answered and didnt bs me. I would say persistence didnt help, but they did get the job done quick. |
| Source |
Crystal R |
| Insurer Policy |
Aetna (us healthcare) |
| Insurer Status | Approved after first letter (04/17/02) |
| Weeks to approval |
2 |
| Comorbidities |
sleep apnea,joint pain,arthritis |
| Policy |
Must be medically necessary |
| Comments |
Dealing with Aetna was not one of the best things i have ever done the gate keepers there are tough and you will never be able to talk to the department that you want but for the most part they were very quick to approve.. As far as persistence i dont think that mattered in any way although i called everyday (the gate keper thing)If you are interested in this surgery then well aetna is the place to be.. |
| Source |
Angela M |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (04/28/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
65.2 |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Martha M |
| Insurer Policy |
Aetna (Patriot X Custom) |
| Insurer Status | Approved after first letter (10/06/02) |
| MD-supervised programs |
2 (14 weeks) |
| Comorbidities |
GERD, PCOS, Insulin Resistance, Herniated Disc |
| Policy |
Must be medically necessary |
| Comments |
So far Aetna has been pretty nice. I've called everyday just to see if they've received my paperwork. I've been told by two different people at Aetna that since they are being so bombarded with paperwork, to have your surgeon call in the request and clinicals. This will speed up the approval time. I'll let you know as I learn more. |
| Source |
Angela L |
